Case of the Month
Section Editor: Nicholas Stence, MD
Children's Hospital Colorado, Aurora, CO
May 2013
Next Case of the Month coming June 4...
Tuberculous Meningitis with Acute Vasculitic Infarcts
- Tuberculous (Tb) meningitis is the most common form of intracranial tuberculosis.
- Vasculitic infarcts are seen in approximately 30-40% of Tb meningitis cases.
- Clinical Presentation: Fever, headache, signs and symptoms of increased intracranial pressure, cranial nerve palsies, seizures, focal neurologic deficit
- Confirmatory Tests: CSF culture (AFB), PCR for M. tuberculosis
- Key Diagnostic Features: Hypodensities (infarcts) associated with abnormal leptomeningeal enhancement. Think Tb especially if leptomeningeal enhancement is more pronounced in the region of the basal cisterns and sylvian fissures. Other associated findings: hydrocephalus and tuberculomas
- Rx: Anti-tuberculous regimen
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