[Acute onset of tuberculous meningoencephalitis presenting with symmetric linear lesions in the bilateral thalamus: a case report].
A 18-year-old woman was admitted to our hospital because of high fever and headache. Nuchal stiffness was present, and a CSF examination showed lymphocyte-domonant pleocytosis and a decreased level of glucose. Although antibiotics, aciclovir and an antimycotic drug were administered, disturbance of consciousness, involuntary movements, and pyramidal tract signs appeared. Soon after the medications were changed to antituberculous medicines, the meningoencephalitis started to subside, and was finally cured. Judging from the clinical findings, the CSF findings, the effectiveness of antituberculous medicines, an elevated ADA level in CSF, and positive conversion in tuberculin tests, the final diagnosis was made as tuberculous meningoencephalitis. At the severest stage of the disease, a brain MRI showed symmetric, linear lesions without the effect of Gd-enhancement in the bilateral thalamus, which thereafter disappeared along with the healing of the illness. From all these things, we conclude that thalamic and other parenchymal lesions should be kept in mind in case of acute tuberculous meningoencephalitis.
Wakai
M
M
Department of Internal Medicine, Kakegawa City General Hospital.
Hayashi
M
M
Honda
K
K
Nishikage
H
H
Goshima
K
K
Yamamoto
J
J
D000208:Acute Disease; D000243:Adenosine Deaminase / Q000134:cerebrospinal fluid; D000293:Adolescent; D000995:Antitubercular Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000134:cerebrospinal fluid; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008590:Meningoencephalitis / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology*; D013788:Thalamus / Q000473:pathology*; D016896:Treatment Outcome; D014390:Tuberculosis, Meningeal / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology*
D000995:Antitubercular Agents; D015415:Biomarkers; D000243:Adenosine Deaminase