title: Lumbar puncture requirement in acute hemiparesis: diagnosis of tuberculous meningitis after hemiparesis in a child.
abstract: BACKGROUND
  Infections are an important acquired cause of cerebral arteriopathy. Tuberculous (TB) meningitis leading to infectious cerebral vasculopathy is a rare cause of acute hemiparesis.
  
  
  METHODS
  A 14-year-old male patient was examined after acute hemiparesis developing within 1 day. Neurological examination revealed total hemiplegia on the left side. Brain MRI findings showed bilateral focal T2-weighted signal hyperintensity in the subcortical and deep white matter regions. There were also areas of restricted diffusion in the right basal ganglia. Although the father had a history of pulmonary TB, the patient had not been given TB prophylaxis because of PPD negativity. At lumbar puncture, opening cerebrospinal fluid (CSF) pressure was 50 cm/H20, CSF protein 66.9 mg/dL, and glucose 54 mg/dL (concurrent blood glucose 93 mg/dL); 170 polymorphonuclear leukocytes per cubic millimeter were present in CSF. Following tests for TB, treatment was started immediately with four anti-TB drugs. TB PCR of CSF and acid-fast bacteria (AFB) staining in gastric aspirate were positive. At clinical follow-up, the patient was able to walk with support at the end of the first month.
  
  
  CONCLUSIONS
  Various infectious agents have been reported as causes of cerebral vasculopathy. TB, which affects a significant number of patients worldwide, should be kept in mind in terms of cerebral vascular complications. Lumbar puncture is essential in order to diagnose TB meningitis.
authors.affiliation: Department of Pediatric Neurology, Faculty of Medicine, Karadeniz Technical University, 61000, Trabzon, Turkey, sevimsahin1@yahoo.com.
authors.forename: Sevim
authors.initials: S
authors.lastname: Sahin
authors.forename: Ali
authors.initials: A
authors.lastname: Cansu
authors.forename: Tülay
authors.initials: T
authors.lastname: Kamaşak
authors.forename: İlker
authors.initials: İ
authors.lastname: Eyüboğlu
authors.forename: Gülnur
authors.initials: G
authors.lastname: Esenülkü
authors.forename: Ayşenur
authors.initials: A
authors.lastname: Ökten
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000995:Antitubercular Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009460:Neurologic Examination; D010291:Paresis / Q000175:diagnosis* / Q000209:etiology; D013129:Spinal Puncture / Q000379:methods*; D020521:Stroke / Q000150:complications / Q000175:diagnosis*; D014390:Tuberculosis, Meningeal / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D000995:Antitubercular Agents