Clinical characteristics and treatment delay of cerebral infarction in tuberculous meningitis.
BACKGROUND
Cerebral infarction (CI) complicating tuberculous meningitis (TBM) is a major risk factor of permanent disability. The prevention of this complication is an important issue in the quality care of TBM patients.


OBJECTIVE
Our aim was to evaluate the clinical characteristics of TBM patients with CI.


METHODS
Ninety-one adult patients with TBM were studied between 1999 and 2007. Clinical, neuroradiological and cerebrospinal fluid data of patients with CI were compared with those without CI.


RESULTS
Thirty of the 91 patients had CI, including symptomatic CI occurring before admission in 10 patients, symptomatic CI occurring during hospitalisation in four and silent CI in 16 patients. When compared with non-CI patients, patients with CI were younger and associated with focal weakness on presentation, and had basal meningeal enhancement and hydrocephalus on brain images. Prolonged doctor delays of antituberculosis and steroid therapies, neurosurgical intervention, focal weakness and dementia as sequelae, and poor outcomes were associated with patients with CI than non-CI patients.


CONCLUSIONS
Contrast-enhanced brain imaging is helpful to explore the basal meningeal enhancement in CI patients, and contributes to early diagnosis and treatment of TBM. Early antituberculosis and steroid therapies may help prevent CI in TBM patients.
Sheu
J-J
JJ
Department of Neurology, Taipei Medical University Hospital, Taipei, Taiwan. jjs2239@tmu.edu.tw
Hsu
C-Y
CY
Yuan
R-Y
RY
Yang
C-C
CC
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D001925:Brain Damage, Chronic / Q000209:etiology / Q000517:prevention & control; D002544:Cerebral Infarction / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D003287:Contrast Media; D057210:Delayed Diagnosis; D005260:Female; D006801:Humans; D007297:Inpatients; D008279:Magnetic Resonance Imaging; D008297:Male; D059906:Neuroimaging; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014390:Tuberculosis, Meningeal / Q000150:complications* / Q000188:drug therapy
D000305:Adrenal Cortex Hormones; D000995:Antitubercular Agents; D003287:Contrast Media