Middle Cerebral Artery Infarction in Central Nervous System Tuberculosis
Abstract
Objective: To show the occurrence of medium vessel vasculitis in patients with central nervous system tuberculosis, meningitis and/or tuberculomas, which we do not see infrequently, but which is rarely reported in the literature.
Methodology: It was a prospective, observational study conducted at Department of Neurology, Dow University of Health Sciences, Karachi from January 2008 to June 2010. (Only five cases presented to Civil Hospital, Karachi directly; out of other five three patients were seen by the primary author at a charitable hospital which does not provide admitting facilities and therefore were brought to Civil Hospital and other two were seen at a private clinic which does offer admission facilities but patients could not financially afford to stay in those hospitals were also brought to Civil Hospital).
Results: A total of 10 patients with central nervous system tuberculosis who also had stroke as a result of medium vessel vasculitis, middle cerebral artery infarction in all of our cases, were analyzed. There was equal number of male and female patients with an age range of 7-54 years. Two patients had stroke at presentation and two developed after 8 weeks of treatment while remaining patients had stroke between 1-4 weeks. None of the patients had evidence of extrneural tuberculosis and only two patients had other risk factors for stroke which were convincingly ruled out as cause for stroke at that time. Three patients also had small vessel vasculitis in addition to larger stroke. Only one patient expired, one made complete recovery and 8 patients made partial recovery.
Conclusion: Although small vessel vasculitis is a known complication of CNS tuberculosis, medium vessel vasculitis is not uncommon and contribute significantly to the mortality and morbidity of the infection.
Methodology: It was a prospective, observational study conducted at Department of Neurology, Dow University of Health Sciences, Karachi from January 2008 to June 2010. (Only five cases presented to Civil Hospital, Karachi directly; out of other five three patients were seen by the primary author at a charitable hospital which does not provide admitting facilities and therefore were brought to Civil Hospital and other two were seen at a private clinic which does offer admission facilities but patients could not financially afford to stay in those hospitals were also brought to Civil Hospital).
Results: A total of 10 patients with central nervous system tuberculosis who also had stroke as a result of medium vessel vasculitis, middle cerebral artery infarction in all of our cases, were analyzed. There was equal number of male and female patients with an age range of 7-54 years. Two patients had stroke at presentation and two developed after 8 weeks of treatment while remaining patients had stroke between 1-4 weeks. None of the patients had evidence of extrneural tuberculosis and only two patients had other risk factors for stroke which were convincingly ruled out as cause for stroke at that time. Three patients also had small vessel vasculitis in addition to larger stroke. Only one patient expired, one made complete recovery and 8 patients made partial recovery.
Conclusion: Although small vessel vasculitis is a known complication of CNS tuberculosis, medium vessel vasculitis is not uncommon and contribute significantly to the mortality and morbidity of the infection.
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