What are Vascular Manifestations of Tuberculous Meningitis?

They found Twenty-nine TBM (96.7%) patients had an abnormality on MRI. MR abnormalities were in varying combinations of leptomeningeal enhancement in 24 (80%), pachymeningeal enhancement in 2 (6.7%), both lepto- and pachymeningeal enhancement in 3 (10%), tuberculomas in 13 (43.3%), ventriculitis in 1 (3.3%), hydrocephalus in 16 (53.3%), and infarcts in 10 (33.3%). Cerebral infarcts were seen in 10 (33.3%) patients, out of which the tubercular zone is involved in 9 patients.

Arterial abnormality on TOF MRA was noted in 13 (43.3%) patients. The significant arterial narrowing was noted in four patients, whereas mild irregularity of vessels was noted in nine patients. Cerebral venous sinus thrombosis (CVST) was noted in two (6.7%) of patients. Both were female.

TBM is the most severe form of extrapulmonary TB. Cerebrovascular complications in TBM have been reported as a poor prognostic predictor. Vascular complications associated with TBM are usually secondary to arteritis causing arterial vasculitic infarcts.

The authors conclude that CVST in tubercular meningitis is rare and the clinical pictures may be overlapping. Early diagnosis and management are required for better outcome of the patient. Contrast-enhanced MRV with postcontrast T1WI is required for diagnosis of sinus thrombosis and meningitis. In TBM, there is predominant arterial involvement causing infarcts. However, occasionally, there may be venous involvement causing CVST.

Reference : Vascular Manifestations of Tuberculous Meningitis: MR Angiography and Venography Study

Suprava Naik , Sanjeev Kumar Bhoi , Nerbadyswari Deep , Sudipta Mohakud , Baijayantimala Mishra , Anupam Dey , Rajesh Kumar , Gautom Kumar Saharia  , Mukesh Kumar

J Neurosci Rural Pract 2022; 13(03): 529-536

DOI: 10.1055/s-0042-1748175