Clinical and laboratory characteristics of cerebral infarction in tuberculous meningitis: a comparative study.
Cerebral infarction as a complication of tubercular (TB) meningitis is not uncommon, but an adequate comparison of patients with and without stroke has not been carried out. This study was performed to evaluate the clinical characteristics of cerebral infarction secondary to TB meningitis, and to investigate predictive factors for cerebral infarction in patients with TB meningitis. Patients with TB meningitis were recruited over a period of 56 months. They were divided into two groups, those with and those without stroke. Demographic features and clinical, laboratory, and neuroradiological findings were compared between the two groups. We classified strokes into subtypes using neuroimaging findings. Of the 38 patients who were diagnosed with TB meningitis, eight also experienced cerebral infarction. The percentage of cerebrospinal fluid leukocytes that were neutrophils was significantly higher in patients with stroke (68%) than in patients without stroke (31%; p=0.0001). Upon initial CT imaging, meningeal enhancement was found in 11 patients, and of these patients, six experienced stroke. There were no significant differences between the groups with respect to other clinical and laboratory features, including demographic features, time between meningitis onset and treatment initiation, peripheral white blood cell count, and cerebrospinal fluid findings. Five of the eight patients who developed stroke had lacunar infarcts. One of the three patients with territorial nonlacunar infarction died due to herniation. When treating patients with TB meningitis, the possibility of cerebral infarction should be considered when patients develop focal neurological signs, meningeal enhancement on a CT scan, and sustained polymorphic cerebrospinal fluid pleocytosis.
Koh
Seong-Beom
SB
Department of Neurology, Korea University College of Medicine, 126-1, Anam-Dong 5-Ga, Seongbuk-Gu, Seoul 136-705, Korea.
Kim
Byung-Jo
BJ
Park
Moon Ho
MH
Yu
Sung-Wook
SW
Park
Kun-Woo
KW
Lee
Dae Hie
DH
D000293:Adolescent; D000328:Adult; D000368:Aged; D002544:Cerebral Infarction / Q000134:cerebrospinal fluid / Q000382:microbiology* / Q000473:pathology*; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D007964:Leukocytosis / Q000134:cerebrospinal fluid; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000166:cytology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020521:Stroke / Q000134:cerebrospinal fluid / Q000382:microbiology / Q000473:pathology; D014057:Tomography, X-Ray Computed; D014390:Tuberculosis, Meningeal / Q000134:cerebrospinal fluid / Q000473:pathology*