Acute ischemic stroke in young adults with tuberculous meningitis

Li-ming, Zhang; Zhang, Xiaoyu; Li, Huaqiang; Chen, Gang; Zhu, Mingqing

doi:10.1186/s12879-019-4004-5

Cited by 27 publications

(36 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Most stroke caused by tuberculous meningitis are small, bilateral, and involve the tubercular zone comprising of caudate, anterior thalamus, anterior limb, and genu of the internal capsule (Figure 1). 33,34 MR angiography in 43% of patients with tuberculous meningitis showed abnormalities, with most frequent involvement of the middle cerebral artery, followed by anterior cerebral artery and internal carotid artery. 35 Post-varicella angiopathy, bacterial meningitis, and aseptic meningitis were other significant risk factors for aterial-ischemic stroke in children with unilateral or bilateral nonprogressive arteriopathy of anterior circulation.…”

Section: Discussionmentioning

confidence: 98%

Etiologic Profile of Childhood Stroke from North India: Is It Different from Developed World?

et al. 2021

View full text Add to dashboard Cite

Objective: To describe the etiology of childhood arterial-ischemic stroke from a developing country and assess short-term neurologic outcome. Methods: Prospective observational study. Consecutive children between the age of >28 days to <12 years, admitted with the diagnosis of arterial-ischemic stroke were enrolled during the study period from January 2017 to December 2018. Short-term neurologic outcome was assessed with Pediatric Cerebral Performance Category (PCPC) scale and Pediatric Stroke Outcome Measure (PSOM). Results: We enrolled 76 children with arterial-ischemic stroke, with a median age of 24 months (interquartile range 12-69), and 43 (57%) were boys. The most common risk factor for childhood arterial-ischemic stroke was arteriopathy in 59 (77%), followed by cardiovascular disorder in 12 (16%) children. Among 59 children with arteriopathy, 32 (42%) had infection-associated arteriopathies, 10 (13%) had mineralizing angiopathy, 10 (13%) had moyamoya disease. Pediatric stroke risk factors were classified according to Pediatric Stroke Classification and CASCADE primary classification. Short-term neurologic outcome was assessed at 3 months in 62 (82%) survivors. Among stroke survivors, 33 (61%) had sensory-motor deficits, and 24 (39%) had severe neurologic disability (PCPC ≥ 4). The presence of fever, encephalopathy, low Glasgow coma score at presentation, seizures, and infection-associated arteriopathy predicted severe neurologic disability at follow-up. Conclusion: The risk factors for pediatric arterial-ischemic stroke are different from developed countries in our cohort. Infection-associated arteriopathies, mineralizing angiopathy, and moyamoya disease are the most common risk factors in our cohort. Two-thirds of pediatric stroke survivors have neurologic disability at short-term follow-up.

show abstract

Section: Discussionmentioning

confidence: 98%

Etiologic Profile of Childhood Stroke from North India: Is It Different from Developed World?

et al. 2021

View full text Add to dashboard Cite

show abstract

“…However, aspirin significantly reduced new onset stroke as compared to placebo in patients with tubercular meningitis [hazard ratio of 0.51 (95% CI as compared to placebo in terms of new onset stroke. Since one of the main complication of tubercular meningitis is cerebral stroke (with reported incidence~13À57%), which can lead to poor clinical outcome [3,10]. Also, the mortality is about three times higher in young tubercular meningitis patients with stroke compared to those without [3,10].…”

Section: Discussionmentioning

confidence: 99%

“…Since one of the main complication of tubercular meningitis is cerebral stroke (with reported incidence~13À57%), which can lead to poor clinical outcome [3,10]. Also, the mortality is about three times higher in young tubercular meningitis patients with stroke compared to those without [3,10]. So, even the NNT of 10 could have potential clinical significance in terms of mortality reduction and prevention of new onset stroke, thus prevention of disability.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of aspirin as an adjunctive therapy in tubercular meningitis: A systematic review and meta-analysis

2021

View full text Add to dashboard Cite

Background: Tubercular meningitis (TBM) is associated with high mortality and stroke with chronic neurological sequelae even with best of care and antitubercular therapy. Studies have shown that aspirin as an adjunctive therapy might play some role in management of TBM. This systematic review and meta-analysis has been planned to evaluate the efficacy and safety of aspirin as an adjunctive therapy in TBM patients. Methods: We conducted a systematic search of randomized controlled trials in patients with tubercular meningitis published till October 2019 in all major clinical journals. Study was registered with PROSPERO with registration number: CRD42019136689. Articles were tested for eligibility and assessed for quality and various bias. Data synthesis and analysis was done using Review manager 5.3. The primary end point for assessment of efficacy was mortality at three months. The secondary end point was stroke or composite outcome of stroke and mortality at three months. Adverse effects were also assessed as secondary safety end point. Findings: Overall, three eligible randomized controlled trials with 365 participants were included that provided quantitative data for this meta-analysis. The analysis of primary and secondary end points was done using fixed effect model. There was not significant reduction in mortality [hazard ratio 0.78 (95% CI 0.45À1.35, p = 0.37)] and composite outcome of mortality and new onset stroke [hazard ratio 0.86 (95% CI 0.60À1.24, p = 0.43)] in aspirin group as compared to placebo. However, aspirin as compared to placebo significantly reduced new onset stroke [hazard ratio of 0.51 (95% CI 0.29À0.87, p = 0.01)]. Interpretation: We did not find significant reduction in mortality and composite outcome (mortality and new onset stroke) with aspirin as compared to placebo but there was significant reduction in new onset stroke in aspirin group as compared to placebo with Number Needed to Treat (NNT) = 10, which might be of clinical importance since stroke is responsible for high mortality and morbidity in these subset of patients. However, a large well conducted randomized controlled trial is required to put more light on the available evidence.

show abstract

“…A higher incidence of stroke was reported in younger children and those with advanced stages of TBM ( 200 ). CSF white cell count and basal meningeal enhancement were identified as independent risk factors for stroke in young TBM patients ( 201 ). Most of the strokes in TBM are multiple, bilateral and located in the basal ganglia ( 198 , 199 ).…”

Section: Neutrophils and Strokes In Cns-tbmentioning

confidence: 99%

Neutrophil-Mediated Immunopathology and Matrix Metalloproteinases in Central Nervous System – Tuberculosis

et al. 2022

View full text Add to dashboard Cite

Tuberculosis (TB) remains one of the leading infectious killers in the world, infecting approximately a quarter of the world’s population with the causative organism Mycobacterium tuberculosis (M. tb). Central nervous system tuberculosis (CNS-TB) is the most severe form of TB, with high mortality and residual neurological sequelae even with effective TB treatment. In CNS-TB, recruited neutrophils infiltrate into the brain to carry out its antimicrobial functions of degranulation, phagocytosis and NETosis. However, neutrophils also mediate inflammation, tissue destruction and immunopathology in the CNS. Neutrophils release key mediators including matrix metalloproteinase (MMPs) which degrade brain extracellular matrix (ECM), tumor necrosis factor (TNF)-α which may drive inflammation, reactive oxygen species (ROS) that drive cellular necrosis and neutrophil extracellular traps (NETs), interacting with platelets to form thrombi that may lead to ischemic stroke. Host-directed therapies (HDTs) targeting these key mediators are potentially exciting, but currently remain of unproven effectiveness. This article reviews the key role of neutrophils and neutrophil-derived mediators in driving CNS-TB immunopathology.

show abstract

Acute ischemic stroke in young adults with tuberculous meningitis

Cited by 27 publications

References 15 publications

Etiologic Profile of Childhood Stroke from North India: Is It Different from Developed World?

Etiologic Profile of Childhood Stroke from North India: Is It Different from Developed World?

Efficacy and safety of aspirin as an adjunctive therapy in tubercular meningitis: A systematic review and meta-analysis

Neutrophil-Mediated Immunopathology and Matrix Metalloproteinases in Central Nervous System – Tuberculosis

Contact Info

Product

Resources

About