title: Seizure heralding tuberculous meningitis.
abstract: Seizures may frequently occur during tuberculous meningitis. We describe a patient with an apparent generalised tonic-clonic seizure, initially not associated with any magnetic resonance imaging (MRI) abnormality, which was the presenting symptom of tuberculous meningitis. Follow-up MRI, performed after gadolinium administration, showed signs of meningeal involvement. Seizures may be the presenting symptoms of tuberculous meningitis even in the absence of evident intracerebral lesions on MRI. Therefore, contrast-enhanced brain MRI should be performed in the diagnostic workup for each first seizure, especially in patients with a clinical suspicion of CNS infectious disease. The term "heraldic seizure", indicating a subset of acute symptomatic seizures presenting at the onset of a brain/systemic injury or preceding the full clinical manifestation of a cerebral insult, may be helpful to classify these seizures retrospectively, based initially on unknown aetiology.
authors.affiliation: Department of Neurological, Neuropsychological, Morphological and Movement Sciences. Section of Clinical Neurology. University of Verona, Italy, Department of Neurology, Franz Tappeiner Hospital, Merano, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Brigo
authors.forename: Harald
authors.initials: H
authors.lastname: Ausserer
authors.forename: Giulio
authors.initials: G
authors.lastname: Zuccoli
authors.forename: Frediano
authors.initials: F
authors.lastname: Tezzon
authors.forename: Raffaele
authors.initials: R
authors.lastname: Nardone
mesh_terms: D001921:Brain; D006801:Humans; D008279:Magnetic Resonance Imaging; D012189:Retrospective Studies; D012640:Seizures / Q000175:diagnosis; D014390:Tuberculosis, Meningeal