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Acute stroke in a child with miliary tuberculosis

J F Schoeman1, G S Rutherfoord, R H Hewlett

  • 1Department of Paediatrics and Child Health, Faculty of Medicine, University of Stellenbosch, Parow, Republic of South Africa.

Clinical Neuropathology
|December 24, 1997
PubMed
Summary

Childhood miliary tuberculosis can cause neurological issues. A rare case showed basilar artery occlusion, a previously undescribed complication of tuberculous meningitis (TBM) in infants.

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Area of Science:

  • Neurology
  • Pediatrics
  • Infectious Diseases

Background:

  • Childhood miliary tuberculosis often co-occurs with tuberculous meningitis (TBM).
  • Cerebral infarction is a known complication of TBM, typically affecting anterior cerebral circulation due to tuberculous periarteritis.
  • Vertebro-basilar system involvement is less common in TBM-related cerebral infarction.

Observation:

  • A 13-month-old infant presented with fever, seizures, and decerebration.
  • Magnetic resonance imaging revealed vertebro-basilar ischemia and cerebral granulomas.
  • Chest radiography showed diffuse miliary tuberculosis.

Findings:

  • The infant's presentation was linked to acute basilar artery occlusion.
  • Postmortem examination confirmed miliary tuberculosis and identified an infected thromboembolus causing the occlusion.

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  • The thromboembolus showed granulomatous inflammation, likely originating from an endocardial vegetation.

    • Implications:

    • This case highlights basilar artery occlusion as a novel and severe complication of TBM in infants.
    • It underscores the importance of considering vascular complications in pediatric TBM.
    • Early recognition and management of TBM-related neurological complications are crucial for improved outcomes.