title: A Combination of Moyamoya Pattern and Cerebral Venous Sinus Thrombosis: A Case of Tubercular Vasculopathy.
abstract: BACKGROUND
  Moyamoya vasculopathy, arising secondary to tubercular meningitis (TBM) is unusual. There have also been a few reports of cerebral venous sinus thrombosis (CVST) in TBM. A case of TBM, complicated simultaneously by Moyamoya syndrome and CVST, is being presented here.
  
  
  METHODS
  A 1-year-old girl presented with febrile encephalopathy, vomiting, seizures and left hemiparesis. Cerebrospinal fluid analysis was suggestive of TBM. Extensive infarcts were noted in the magnetic resonance imaging, involving right middle cerebral artery (MCA), anterior cerebral artery and the left MCA. Magnetic resonance venogram revealed left transverse venous sinus thrombosis and magnetic resonance angiography showed bilateral moyamoya pattern of arteriopathy. Patient was started on antitubercular therapy and low molecular weight heparin.
  
  
  CONCLUSIONS
  Early vascular involvement affecting both arterial and venous structures has not hitherto been reported in CNS tuberculosis. Early recognition of secondary complications of CNS tuberculosis is crucial to prevent the morbidity and mortality associated with TBM.
authors.affiliation: Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India.
authors.forename: Ranjith M
authors.initials: RM
authors.lastname: Kumar
authors.affiliation: Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India.
authors.forename: Lokesh
authors.initials: L
authors.lastname: Saini
authors.affiliation: Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India.
authors.forename: Jaya Shankar
authors.initials: JS
authors.lastname: Kaushik
authors.affiliation: Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India.
authors.forename: Biswaroop
authors.initials: B
authors.lastname: Chakrabarty
authors.affiliation: Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India.
authors.forename: Atin
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India sheffalig@yahoo.com.
authors.forename: Sheffali
authors.initials: S
authors.lastname: Gulati
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006493:Heparin / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D020768:Middle Cerebral Artery; D009072:Moyamoya Disease / Q000175:diagnosis*; D012851:Sinus Thrombosis, Intracranial / Q000175:diagnosis* / Q000188:drug therapy; D016896:Treatment Outcome; D014390:Tuberculosis, Meningeal / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D000925:Anticoagulants; D000995:Antitubercular Agents; D006493:Heparin
keywords: cerebral venous sinus thrombosis; moyamoya pattern; tubercular meningitis; tubercular vasculopathy