Tuberculous meningitis leading to stroke: a case report.

Autor:	Aryal E; Upendra Devkota Memorial National Institute of Neurological and Allied Sciences, Bansbari, Kathmandu, Nepal., Adhikari A; Upendra Devkota Memorial National Institute of Neurological and Allied Sciences, Bansbari, Kathmandu, Nepal., Adhikari A; Nepalese Army Institute of Health Sciences, College of Medicine, Kathmandu, Nepal., Bhattarai D; Upendra Devkota Memorial National Institute of Neurological and Allied Sciences, Bansbari, Kathmandu, Nepal., Shakya S; Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal., Paudel A; Manmohan Memorial College and Teaching Center, Swayambu, Kathmandu, Nepal., Dhonju K; Nepalese Army Institute of Health Sciences, College of Medicine, Kathmandu, Nepal., Ranjini NJ; Government Medical College, Kozhikode, Kerala, India., Sharma A; Nepalese Army Institute of Health Sciences, College of Medicine, Kathmandu, Nepal., Dahal MR; Upendra Devkota Memorial National Institute of Neurological and Allied Sciences, Bansbari, Kathmandu, Nepal.
Jazyk:	angličtina
Zdroj:	Annals of medicine and surgery (2012) [Ann Med Surg (Lond)] 2024 Oct 11; Vol. 86 (11), pp. 6882-6888. Date of Electronic Publication: 2024 Oct 11 (Print Publication: 2024).
DOI:	10.1097/MS9.0000000000002647
Abstrakt:	Introduction: Tuberculosis is a major public health issue in developing countries. Vasculitis, resulting from tubercular meningitis, can lead to stroke. Case Presentation: A 33-year-old male presented to the Emergency Department with relapsing-remitting fever with an evening rise in temperature for 1 month, personality changes (aggression and mutism) for 2 weeks, followed by difficulty in moving his lower limbs, and bowel and bladder incontinence. Neck rigidity, a positive Kernig's sign, bilateral mute plantar responses, and 0/5 power in bilateral lower limbs were noted on examinations. MRI of the brain was suggestive of tubercular meningitis and showed an infarct with hemorrhagic transformation in the relatively uncommon, right basifrontal lobe. Gene Xpert test done on cerebrospinal fluid confirmed the diagnosis. Discussion: Tuberculous meningitis leading to infarct is a challenging diagnosis due to nonspecific symptoms and variable cerebrospinal fluid AFB staining results. Radiological imaging with MRI helps in suggesting the diagnosis and Gene Xpert confirms the diagnosis. Antitubercular therapy, steroids, physiotherapy, and supportive care are part of management. Conclusion: This case highlights the importance of considering tubercular meningitis-related cerebral infarction despite initial negative CSF AFB stain. Radiological investigation may help in guiding the clinician towards a diagnosis of tuberculous meningitis with vasculitis. Competing Interests: The authors declare no conflicts of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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