Open AccessEvolving Stroke in Tuberculous Meningitis
Author(s) -
Seng Wee Cheo,
Rosdina Zamrud Ahmad Akbar,
Song Weng Ryan Khoo,
Yan Tan,
Qin Jian Low
Publication year - 2021
Publication title -
borneo journal of medical sciences
Language(s) - English
Resource type - Journals
eISSN - 2710-7353
pISSN - 1985-1758
DOI - 10.51200/bjms.vi.2487
Subject(s) - tuberculous meningitis , medicine , pyrazinamide , hydrocephalus , tuberculosis , dexamethasone , stroke (engine) , vomiting , lumbar puncture , surgery , rifampicin , meningitis , tuberculoma , complication , myelitis , pediatrics , cerebrospinal fluid , pathology , mechanical engineering , psychiatry , spinal cord , engineering
Tuberculous meningitis (TBM) is the most severe form of extra-pulmonary tuberculosis which carries high mortality with 100% mortality without treatment. A neurological complication of TBM includes hydrocephalus, brain abscess and stroke. In this report, we would like to illustrate a case of stroke in a patient with TBM. In this case, a 37-year old man initially presented with fever for 1 week associated with severe headache and occasional vomiting. Computed tomography (CT) of the brain showed leptomeningeal enhancement and lumbar puncture findings consistent with infective in nature. His MARAIS score was 13 and was treated as tuberculous meningitis with anti-tuberculous therapy. While in the ward, he developed right-sided body weakness with evolving CT brain findings. His condition then stabilized with anti-tuberculous treatment which consists of isoniazid, rifampicin, pyrazinamide and streptomycin. Dexamethasone was also initiated. On follow up, his condition further improves and is functionally independent. In conclusion, tuberculous meningitis is an aggressive disease with high morbidity. Stroke can occur as a result of TBM. Timely initiation of treatment is important in improving the outcome of the patients.