Malignant middle-cerebral artery territory infarction in tuberculous vasculitis

Intracranial large vessel involvement is an unusual complication of tuberculous meningitis. The authors report a 39-year-old female presenting with an episode of seizure, followed by rapid decline in sensorium without prominent systemic features. An initial cranial magnetic resonance imaging revealed tuberculomata and patchy infarcts. Despite antituberculous therapy, she progressively worsened. A cranial computed tomography scan done following the worsening revealed a massive middle-cerebral artery (MCA) infarct. Unfortunately, the patient died in spite of decompressive craniotomy. Malignant MCA territory infarct is a rare and potentially fatal complication of tuberculous meningitis