Hence, if pza cannot be tolerated, the treatment course for tbm should be lengthened to a total of 18 months. Treating individuals exhibiting the signs of nonactive or dormant tuberculosis can help to. Tuberculous meningitis causes significant morbidity and mortality, especially if diagnosis and treatment are late. Frequency and impact of cerebral infarctions in patients. Stroke in tuberculous meningitis tbm occurs in 1557% of patients. Longterm mortality of patients with tuberculous meningitis in new york city. Predictors of stroke in patients of tuberculous meningitis and its. The influence of hiv coinfection on clinical manifestations and outcome of tbm is not well defined. Therefore, the aim of our study was to identify risk factors for acute ischemic stroke in young adults with tbm. Acute ischemic stroke in young adults with tuberculous meningitis. Cerebrovascular complications in tuberculous meningitisa. Some 6,000 cases of pneumococcal meningitis are reported in.
Tuberculous meningitis tbm is one of the most severe forms of. Hypovolemia due to cerebral salt wasting may contribute to. Tbm is typically a subacute disease with symptoms that may persist for weeks before diagnosis. Tuberculous meningitis tbm is a devastating disease. Cerebral infarction occurs in 1557% of tuberculous meningitis patients, mainly during stage three of the illness 3.
Inquire about the patients medical and social history, including recent contact with patients with tuberculosis tb. Indian national guidelines for extrapulmonary tb estimates that tbm constitutes 1%. Tuberculous meningitis was first described as a distinct pathological entity in 1836,18 and robert koch demonstrated that tuberculosis was caused bymycobacterium tuberculosis in 1882. Stroke in tuberculous meningitis request pdf researchgate. Information about the openaccess article stroke in a patient with tuberculous meningitis and hiv infection in doaj. Mortality and serious longterm sequelae still occur in about 50% of patients with tuberculous meningitis. Tuberculous and fungal meningitis are less common in the united. Tuberculous meningitis is also known as tb meningitis or tubercular meningitis. A clinically focal neurological deficit in tbm can occur in up to 20% of patients 12. Dexamethasone for the treatment of tuberculous meningitis. Stroke in patients with tuberculous meningitis in a low tb.
Clinical outcomes of patients with drugresistant tuberculous meningitis treated with an intensified antituberculosis regimen. Cerebral tryptophan metabolism and outcome of tuberculous. Cerebral infarction occurs in 1557% of tuberculous meningitis patients, mainly during stage three of the illness. Tuberculous meningitis tbm has a wide range of clinical manifestations with aphasia being one of the rarest forms of initial presentation. A comparative study of serum vascular endothelial growth.
The majority of strokes may be asymptomatic because of being in a silent area, deep coma or associated pathology such as spinal arachnoiditis or tuberculoma. Stroke is common in tuberculous meningitis tbm, and aspirin has been shown to reduce mortality. Csf tryptophan concentrations in tuberculous meningitis are under strong genetic influence, probably contributing to the variable outcomes of tuberculous meningitis. Several studies have observed that about 20% of tbm patients develop a stroke during the illness 4.
Yet, some differences have been observed and stroke has been recorded to occur more frequently. Stroke in a patient with tuberculous meningitis and hiv. Furthermore, disturbance of csf circulation leads to an increased intracranial pressure. A combination of aspirin and corticosteroid may be more useful in this condition.
Stroke in tuberculous meningitis tbm occurs in 1557% of patients especially in advance stage and severe illness. Tuberculous meningitis tbm is the most devastating and disabling form with around 1 lakh. Symptomatic strokes in tuberculous meningitis often present with dense hemiplegia. As the disease progresses, the symptoms will become more serious.
Pneumococcal meningitis is the most common form of meningitis and is the most serious form of bacterial meningitis. The walls of small and mediumsized arteries that traverse the exudate are invaded by inflammatory cells. Stroke is reported in about 57% of patients with tuberculous meningitis tbm depending on the method of evaluation. To evaluate the effect of aspirin and corticosteroid adjunctive therapy alone or in combination in determining the outcome of tbm. Tuberculous meningitis is mycobacterium tuberculosis infection of the meninges the system of membranes which envelop the central nervous system. Characteristic cerebrospinal fluid csf findings of tbm include a lymphocyticpredominant pleiocytosis, elevated protein, and low. Just over a third of all cases survives with no problems. You get it when a virus enters the body through the nose or mouth and travels to the brain. Pza has excellent penetration into the csf and is a key drug in reducing the total treatment time for drugsusceptible tb 41. Ischemic stroke is a common complication in patients with tuberculous meningitis tbm, which is. Although stroke is seen in approximately 20% of patients with tbm, the underlying vascular damage and infarction are much more extensive.
Vascular complications have the most serious consequences in patients with tuberculous meningitis tbm. Cerebral infarction occurs in 1557% of tuberculous meningitis patients, mainly. Authors contributions this work was carried out in collaboration between all the authors. Ischemic stroke in the setting of tuberculous meningitis. Pathogenesis dissemination of bacilli to the meninges and brain occurs as a complication of the primary infection, or as a complication of an existing tb lesion tuberculoma, miliary tb or reactivation of. Tuberculous meningitis causes significant morbidity and mortality, especially if diagnosis and treatment are late 1. Tuberculous meningitis tbm is the most common form of central nervous system tuberculosis tb and has very high morbidity and mortality. Tuberculosis and the risk of ischemic stroke stroke. Muhammad azharuddin 1, ishan lalani 1, doantrang du 1 and wael ghali 1. Stroke with bacterial meningitis very urgent haseeb123 posted. Tuberculous meningitis tbm is difficult to diagnose, and a high index of suspicion is needed to make an early diagnosis. Tuberculous meningitis prevention the bcg vaccination can help to prevent tbm in young children living n places where this disease is quite common.
Pdf acute stroke secondary to tuberculous meningitis. Ischemic stroke is a relatively frequent complication of tuberculous meningitis and occurs in about 30% of cases 18. Does adjunctive corticosteroid and aspirin therapy improve. Ischemic stroke is a sudden onset of a focal neurologic deficit that can cause morbidity and mortality in the countries. Tuberculous meningitis tbm is a chronic infection of the meninges caused by mycobacterium tuberculosis. Building up of fluids between skull and the brain subdural effusion tuberculous radiculomyelitis or tbrm is a rare form of complication of tuberculous meningitis that has only been reported recently. Cerebral infarction pattern in tuberculous meningitis ncbi. Because of a lack of clinical evidence linking stroke to tuberculosis, except tuberculous meningitis, patients with a tuberculosis diagnosis are usually followedup by their chest or infection physician, but not by a neurologist in clinical practice. Diagnosis, initial management, and prevention of meningitis. Tuberculous meningitis is the severest form of infection with mycobacterium tuberculosis, causing death or severe neurologic deficits in more than half of those affected in spite of antituberculosi. However, risk factors of stroke in tbm patients were not fully understood, especially in those young adults.
However, the evidence base guiding the care of critically ill patients with tuberculous. Stroke in tuberculous meningitis journal of the neurological. In tuberculous meningitis, the meningeal inflammation produces a basilar, gelatinous inflammatory exudate in the subarachnoid space. Tuberculous meningitis is the most severe form of tuberculosis and often causes critical illness with high mortality. We report a 27year old male man who developed multiple cerebral infarctions as the first manifestation of tuberculous meningitis and. Classic symptoms of meningitis, such as stiff neck, headache, and light sensitivity.
While sm or emb are traditionally used as the fourth antitb agent in tbm. Frequency and impact of cerebral infarctions in patients with. Research article open access acute ischemic stroke in young adults with tuberculous meningitis liming zhang1, xiaoyu zhang2, huaqiang li1,3, gang chen1 and meijia zhu2 abstract background. Tuberculous meningitis tbm is one of the most devastating presentations of tuberculosis tb, which constitutes about 10% of all tb cases and is responsible for about 40% of the deaths of tb in developing countries. Stroke is a common complication of tuberculous meningitis. Tuberculous meningitis tbm occurs in 4% of patients with tuberculosis 2. This study evaluat ed the frequency, clinical characteristics, risk factors and outcomes of patients with tbm complicated by stroke ad. Stroke is a wellknown complication of tbm, and is regarded as a complication of duration of tbm 4. Acute ischemic stroke in young adults with tuberculous. The risk for tb meningitis includes immunodeficiency, malignancy, hiv infection, malnutrition, diabetes mellitus, alcohol abuse, chronic kidney disease and silicosiss 6, 7.
The majority of strokes may be asymptomatic because of. Cerebral tryptophan metabolism, which is known to affect mycobacterium tuberculosis growth and cns inflammation, is important for the outcome of tuberculous meningitis. Tuberculous meningitis tbm occurs in 4% of patients with tuberculosis. Meningitis stroke tuberculosis abstract mortality and serious longterm sequelae still occur in about 50% of patients with tuberculous meningitis. Predictors of stroke in patients of tuberculous meningitis. It has been reported that incidence of stroke is about 57% in. The main complications of tbm include cerebral stroke, hydrocephalus and tuberculoma formation.
Two primary management objectives are reducing intracranial pressure, and optimising cerebral perfusion, while killing the bacteria and controlling intracerebral inflammation. Meningitis is inflammation of the thin tissue that surrounds the brain and spinal cord, called the meninges. Tuberculous meningitis is the most severe form of tb, difficult to diagnose and treat, and with a grim prognosis. In this case report, we present a previously healthy 24yearold woman that presented with a sudden onset of aphasia.
Cerebral infarction pattern in tuberculous meningitis. The neurocritical care of tuberculous meningitis the. There is no proven treatment or prevention of stroke in tbm. Tuberculous meningitis in children continues to be associated with a significant risk of death even with treatment 19%, and a significant proportion of the surviving children have ongoing neurological problems. Ischemic stroke is a common complication in patients with tuberculous meningitis tbm, which is associated with poor clinical outcome. Infracts can either be asymptomatic or symptomatic. Backgroundcerebrovascular complications of tuberculous meningitis tbm are associated with increased morbidity and mortality. The objective of this study was to evaluate the pr. Tuberculous menigitis tbm presents a major health burden around the world, especially in individuals with concomitant hiv infection, in whom mortality is. Conduction aphasia as initial manifestation of tuberculous. Stroke due to brain vascular disease is a serious complication of tuberculous meningitis tbm. There is a paucity of data regarding comparison of vegf levels in patients of tbm with and without stroke. Bacterial meningitis can cause stroke, hearing loss, and permanent brain damage.
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