title: Cerebral infarction pattern in tuberculous meningitis.
abstract: Tuberculous meningitis (TBM) causes significant morbidity and mortality. The primary objective was to re-examine the concept of "TB zone" and "ischaemic zone" in cerebral infarction in patients with tuberculous meningitis. The secondary objective was to evaluate cerebral infarction, vasculitis and vasospasm in tuberculous meningitis infections. Between 2009 and 2014, TBM patients were recruited. Neuroimaging was performed and findings of cerebral infarction, vasculitis and vasospasm were recorded. Infarcts were classified based on arterial supply and Hsieh's classification. Fifty-one TBM patients were recruited of whom 34 patients (67%) had cerebral infarction. Based on Hsieh's classification, 20 patients (59%) had infarcts in both "TB zone" and "ischaemic zones". 12 patients (35%) had infarcts in "ischaemic zone" and two (6%) patients had infarcts in "TB zone". In terms of vascular supply, almost all patients (35/36) had infarcts involving perforators and cortical branches. 25 patients (73%) and 14 patients (41%) had infarcts supplied by lateral lenticulostriate and medial lenticulostriate arteries respectively. 15 patients (37%) had vasculitis. Vasospasm was present in six patients (15%). 29 patients (85%) with cerebral infarction also had leptomeningeal enhancement (p = 0.002). In summary, infarcts involved mainly perforators and cortical branches, rather than "TB zone" versus "ischaemic zone".
authors.affiliation: Division of Neurology, Department of Medicine, University Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia.
authors.forename: Mei-Ling Sharon
authors.initials: MS
authors.lastname: Tai
authors.affiliation: Department of Neurology, Hospital Kuala Lumpur, Jalan Pahang, 50586 Kuala Lumpur, Malaysia.
authors.forename: Shanthi
authors.initials: S
authors.lastname: Viswanathan
authors.affiliation: Department of Biomedical Imaging, Faculty of Medicine, University Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia.
authors.forename: Kartini
authors.initials: K
authors.lastname: Rahmat
authors.affiliation: Department of Biomedical Imaging, Faculty of Medicine, University Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia.
authors.forename: Hazman Mohd
authors.initials: HM
authors.lastname: Nor
authors.affiliation: Department of Biomedical Imaging, Faculty of Medicine, University Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia.
authors.forename: Khairul Azmi Abdul
authors.initials: KAA
authors.lastname: Kadir
authors.affiliation: Division of Neurology, Department of Medicine, University Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia.
authors.forename: Khean Jin
authors.initials: KJ
authors.lastname: Goh
authors.affiliation: Department of Biomedical Imaging, Faculty of Medicine, University Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia.
authors.forename: Norlisah
authors.initials: N
authors.lastname: Ramli
authors.affiliation: Department of Biomedical Imaging, Faculty of Medicine, University Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia.
authors.forename: Fatimah Kamila Abu
authors.initials: FKA
authors.lastname: Bakar
authors.affiliation: Department of Radiology, Hospital Kuala Lumpur, Jalan Pahang, 50586 Kuala Lumpur, Malaysia.
authors.forename: Norzaini Rose Mohd
authors.initials: NRM
authors.lastname: Zain
authors.affiliation: Division of Neurology, Department of Medicine, University Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia.
authors.forename: Jun Fai
authors.initials: JF
authors.lastname: Yap
authors.affiliation: Department of Medicine, Hospital Alor Setar. Jalan Langgar, 05460 Alor Setar, Malaysia.
authors.forename: Beng Hooi
authors.initials: BH
authors.lastname: Ong
authors.affiliation: Department of Neurology, Hospital Kuala Lumpur, Jalan Pahang, 50586 Kuala Lumpur, Malaysia.
authors.forename: Mohd Hanip
authors.initials: MH
authors.lastname: Rafia
authors.affiliation: Division of Neurology, Department of Medicine, University Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia.
authors.forename: Chong Tin
authors.initials: CT
authors.lastname: Tan
mesh_terms: D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D002544:Cerebral Infarction / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D014390:Tuberculosis, Meningeal / Q000150:complications*; D014657:Vasculitis / Q000150:complications; D020301:Vasospasm, Intracranial / Q000150:complications