Cerebral hemorrhage due to tuberculosis meningitis: a rare case report and literature review

Abstract

Tuberculosis (TB) is a common disease to threaten human health. TB of the central nervous system (CNS) is rare but the most serious type of systemic TB because of its high mortality rate, serious neurological complications and sequelae. In this case report, we describe a woman who presented with walking instability, intracerebral hemorrhage and leptomeningeal enhancement due to tuberculosis meningitis. The patient had no significant medical history and the initial clinical symptoms were walking instability. On analysis, the cerebrospinal fluid was colorless and transparent, the pressure was more than 400 mm H2O, there was lymphocytic pleocytosis, increased protein, and decreased glucose levels present. No tuberculosis or other bacteria were detected. The patient's brain computed tomography image showed intra-cerebral hemorrhage (ICH) and contrast magnetic resonance imaging showed ICH in the right frontal lob, and leptomeningeal enhancement. CNS TB is rare but has a high mortality rate. As this disease has no unique characteristics at first presentation such as epidemiology and obvious clinical manifestation, a diagnosis of CNS TB remains difficult.

Neuroimaging Findings in Tuberculosis: A Single‐Center Experience in 559 Cases

“…CNS TB has a myriad of imaging appearances. It can present either in a diffuse form such as basal exudative leptomeningitis or in a localized form such as tuberculoma, abscess, cerebritis, or ventriculitis . Among these, meningitis (95%) and tuberculomas (2%) are the most common manifestations .…”

“…It can present either in a diffuse form such as basal exudative leptomeningitis or in a localized form such as tuberculoma, abscess, cerebritis, or ventriculitis. 7,8 Among these, meningitis (95%) and tuberculomas (2%) are the most common manifestations. 9,10 However, only 10% of patients with tuberculoma have tuberculous meningitis.…”

The Diagnostic Deceiver: Radiological Pictorial Review of Tuberculosis

“…TB can involve the CNS in 10% of cases, and it is the most devastating form of systemic TB, due to its serious neurological complications and sequelae, with high mortality rate [ 24 , 25 ]. In the majority of cases, infection comes via hematogenous spread from a pulmonary focus and is rarely via a direct spread from paranasal sinuses, mastoids, or orbit.…”

A 30-Year-Old Male Patient of Miliary Tuberculosis Presented with Pancytopenia and Intracerebral Haemorrhage Mimicking Brain Tumor in MRI

“…Cerebral tuberculosis can cause mycotic aneurysm or it may weaken the cerebral vessel walls. 5,6 Both may lead to rupture of cerebral vessels with resultant intracerebral, intraventricular and subarachnoid hemorrhages5,6 ere are case reports supporting tuberculosis as a cause of intracranial bleedings. On many occasions diagnosis is made at autopsy.…”

“…On many occasions diagnosis is made at autopsy. 5,6 Also the timing of intracerebral hemorrhage can vary in intracerebral tuberculosis. It can be the presentation of the disease or it can happen anytime during ATT.…”