title: Stroke in patients with tuberculous meningitis in a low TB endemic country: an increasing medical emergency?
abstract: Stroke due to brain vascular disease is a serious complication of tuberculous meningitis (TBM). This study evaluated the frequency, clinical characteristics, risk factors and outcomes of patients with TBM complicated by stroke admitted to the Infectious Disease Clinic, University of Perugia Hospital, Italy from 1971 to 2010. Over four decades, 419 patients were admitted with tuberculosis, of these 30 (7.1%) were diagnosed with TBM: 20 definite, one probable and nine possible. Twenty-six were evaluable for stroke and six (23%) had stroke. The latter six had advanced stages of meningitis, two tested HIV positive, three HIV negative and in one HIV was not performed. Of seven patients without stroke tested for HIV, only one resulted positive. No differences were found regarding CSF cell count, sugar, protein, microscopy or growth of Mycobacterium tuberculosis among patients with or without stroke. The overall survival rate at discharge was 83% in patients with stroke and 95% in those without stroke. It was found that stroke can be frequent among patients with TBM and the presence of HIV infection might be associated with a higher rate of stroke. Further research is needed on these findings, especially in low TB endemic countries.
authors.affiliation: Infectious Disease Section, Department of Experimental Medicine and Biochemical Sciences, University of Perugia, Perugia, Italy. pasticci@unipg.it
authors.forename: Maria Bruna
authors.initials: MB
authors.lastname: Pasticci
authors.forename: Maurizio
authors.initials: M
authors.lastname: Paciaroni
authors.forename: Piero
authors.initials: P
authors.lastname: Floridi
authors.forename: Lisa
authors.initials: L
authors.lastname: Malincarne
authors.forename: Matteo
authors.initials: M
authors.lastname: Scavizzi
authors.forename: Franco
authors.initials: F
authors.lastname: Baldelli
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D009169:Mycobacterium tuberculosis / Q000254:growth & development / Q000302:isolation & purification / Q000502:physiology; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D015996:Survival Rate; D014376:Tuberculosis / Q000453:epidemiology / Q000382:microbiology; D014390:Tuberculosis, Meningeal / Q000150:complications* / Q000382:microbiology; D055815:Young Adult