title: MR angiography in tuberculous meningitis.
abstract: BACKGROUND
  Infarctions in tuberculous meningitis (TBM) are common but there is a paucity of studies on MR angiography (MRA).
  
  
  OBJECTIVE
  To evaluate the pattern and predictors of MRA abnormality in patients with TBM.
  
  
  METHODS
  Sixty-seven patients with TBM were subjected to clinical, laboratory, magnetic resonance imaging (MRI), and MRA evaluation. The severity of meningitis, focal deficit, CSF findings, and stroke co-morbidities were recorded. Presence of exudates, infarction, hydrocephalous, and tuberculoma on MRI were noted. On intracranial MRA, occlusion or more than 50% narrowing of proximal middle cerebral artery (MCA), anterior cerebral artery (ACA) and posterior cerebral artery (PCA), and basilar artery were considered abnormal. The MRA abnormality was correlated with clinical, laboratory, and MRI findings.
  
  
  RESULTS
  Sixty-seven patients, aged 3-75 years (median 34 years) were included. MRI was abnormal in 61 (91%) patients; basal exudates in 24, hydrocephalous in 23, tuberculoma in 33, and infarction in 40. MRA was abnormal in 34 (50.7%); MCA was most commonly involved (n = 21), followed by PCA (n = 14), ICA (n = 8), ACA (n = 5), basilar artery (n = 5), and vertebral and superior cerebellar artery (1 each). One-fourth of the patients had abnormality in both anterior and posterior circulations. MRA abnormality was related to hydrocephalous and infarction; corresponding infarct was present in 61.8% patients; 41.7% patients with abnormal MRA developed infarct at 3 months but none with normal MRA.
  
  
  CONCLUSIONS
  Half the patients with TBM had MRA abnormality involving both anterior and posterior circulations and 61.8% of them had corresponding infarcts.
authors.affiliation: Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
authors.forename: Jayantee
authors.initials: J
authors.lastname: Kalita
authors.forename: Sreeram
authors.initials: S
authors.lastname: Prasad
authors.forename: Pradeep K
authors.initials: PK
authors.lastname: Maurya
authors.forename: Sunil
authors.initials: S
authors.lastname: Kumar
authors.forename: Usha K
authors.initials: UK
authors.lastname: Misra
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D020771:Anterior Cerebral Artery / Q000473:pathology; D001488:Basilar Artery / Q000473:pathology; D002544:Cerebral Infarction / Q000150:complications / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000473:pathology; D020769:Posterior Cerebral Artery / Q000473:pathology; D014390:Tuberculosis, Meningeal / Q000150:complications / Q000473:pathology*; D055815:Young Adult