title: Cerebral hemorrhage due to tuberculosis meningitis: a rare case report and literature review.
abstract: Tuberculosis (TB) is a common disease to threaten human health. TB of the central nervous system (CNS) is rare but the most serious type of systemic TB because of its high mortality rate, serious neurological complications and sequelae. In this case report, we describe a woman who presented with walking instability, intracerebral hemorrhage and leptomeningeal enhancement due to tuberculosis meningitis. The patient had no significant medical history and the initial clinical symptoms were walking instability. On analysis, the cerebrospinal fluid was colorless and transparent, the pressure was more than 400 mm H2O, there was lymphocytic pleocytosis, increased protein, and decreased glucose levels present. No tuberculosis or other bacteria were detected. The patient's brain computed tomography image showed intra-cerebral hemorrhage (ICH) and contrast magnetic resonance imaging showed ICH in the right frontal lob, and leptomeningeal enhancement. CNS TB is rare but has a high mortality rate. As this disease has no unique characteristics at first presentation such as epidemiology and obvious clinical manifestation, a diagnosis of CNS TB remains difficult.
authors.affiliation: Department of Infection Diseases, Zhejiang Provincial People's Hospital, Hangzhou, China.
authors.forename: Hai
authors.initials: H
authors.lastname: Zou
authors.affiliation: Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Ke-Hua
authors.initials: KH
authors.lastname: Pan
authors.affiliation: Department of Infection Diseases, Zhejiang Provincial People's Hospital, Hangzhou, China.
authors.forename: Hong-Ying
authors.initials: HY
authors.lastname: Pan
authors.affiliation: Department of Hepatobiliary Surgery, Zhejiang Provincial People's Hospital, Hangzhou, China.
authors.forename: Dong-Sheng
authors.initials: DS
authors.lastname: Huang
authors.affiliation: Department of Infection and Liver Diseases, Liver Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.|Institute of Hepatology, Wenzhou Medical University, Wenzhou, China.
authors.forename: Ming-Hua
authors.initials: MH
authors.lastname: Zheng
mesh_terms: D000368:Aged; D002533:Cerebral Angiography / Q000379:methods; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000382:microbiology* / Q000503:physiopathology; D017809:Fatal Outcome; D005260:Female; D005684:Gait; D006801:Humans; D018810:Magnetic Resonance Angiography; D008578:Meninges / Q000382:microbiology* / Q000473:pathology / Q000503:physiopathology; D011237:Predictive Value of Tests; D014057:Tomography, X-Ray Computed; D014390:Tuberculosis, Meningeal / Q000150:complications / Q000175:diagnosis / Q000382:microbiology* / Q000503:physiopathology; D016138:Walking
keywords: central nervous system; intracerebral hemorrhage; leptomeningeal enhancement; tuberculosis meningitis