Tarek Goda, Wael Mahmoud, Karam Selim, Khaled A. M. El Sharkawy

Department of Neurology, Zagazig University; Egypt

Background: Cerebral infarction secondary to infection has been reported as a complication of tuberculosis (TB) meningitis. Objective: This study was performed to investigate predictive factors for cerebral infarction in patients with TB meningitis. Patients and Methods: Between Nov 2009 and Nov 2011, we prospectively collected 22 patients with TB meningitis from Zagazig university hospitals. Their ages ranged from 22 to 60 years. Patients with TB meningitis were divided into two groups, those with and those without stroke. Demographic features and clinical, laboratory findings were compared between the two groups. Results: from 22 patients who were diagnosed with TB meningitis, seven experienced cerebral infarction. Patients with more advanced stage of the disease developed stroke more frequently, and this difference was statistically significant. Patients with positive meningeal enhancement on CT brain developed stroke more frequently than patients with negative enhancement, and this difference was also statistically significant. The percentage of cerebrospinal fluid (CSF) leukocytes (that were neutrophils) was significantly higher in patients with stroke than in patients without stroke. There were no significant differences between the groups with respect to other clinical and laboratory features. Conclusion: When treating patients with TB meningitis, the possibility of cerebral infarction should be considered in patients with advanced disease at presentation ,those with meningeal enhancement on  initial CT scan, and sustained polymorphic CSF pleocytosis. [Egypt J Neurol Psychiat Neurosurg.  2012; 49(3): 271-275]

Key Words: Tuberculosis  meningitis; Cerebral infarction;  CSF pleocytosis;