Global Frequency and Clinical Features of Stroke in Patients With Tuberculous Meningitis

Abstract

IMPORTANCE Stroke in tuberculous meningitis (TBM) is associated with significant morbidity and mortality.OBJECTIVE To determine the country-specific, regional, and overall prevalence of stroke among patients with TBM, including their clinical manifestations, stroke locations, and outcomes.EVIDENCE REVIEW This systematic review searched records in MEDLINE by PubMed, Scopus, and EMBASE until July 2020 for relevant articles on the occurrence and characteristics of stroke in TBM.Randomized clinical trials and cohort studies that included a population of patients with TBM were analyzed for clinical manifestations, type of stroke, area of stroke, vascular territory, and outcomes.Studies that did not report the occurrence of stroke, reported as abstract only with no full-texts available, and articles not in English were excluded. The country-specific, regional, and overall frequencies of stroke among patients with TBM were determined; secondary analysis enumerated the summary estimates of the clinical presentations, common locations of stroke, and outcomes. The Murad tool was used to assess methodological quality.FINDINGS From 852 articles identified, 71 studies involving 2194 patients with stroke in TBM were included. The sample size for each study ranged from 17 to 806 patients. The frequency of stroke in TBM showed an estimate of 0.30 (95% CI, 0.26-0.33). The most common clinical manifestations were fever and headache. The lateral striate, middle cerebral, and medial striate arteries were typically affected. The basal ganglia, cortex and lobar, and internal capsule were the frequently involved areas of the brain. The pooled proportions of mortality and poor outcomes were 0.22 (95% CI, 0.16-0.29) and 0.51 (95% CI, 0.37-0.66), respectively. CONCLUSIONS AND RELEVANCEThe results of this systematic review suggest that stroke is considerably frequent among patients with TBM. The reported frequencies of stroke in TBM and its clinical features vary across the studies and populations.

Rehabilitation of a rare presentation of tuberculous meningoencephalitis: a case report

“…A systematic review showed that the global frequency of stroke in TBM is approximately 30%, meaning that 3 out of 10 patients with TBM will eventually develop a stroke. 6,7 The pathophysiologic mechanism responsible for cerebral infarction includes obliterative vasculitis, intimal proliferation and hypercoagulable state. 3 Among the involved vascular territories, the most affected by TB are those from the anterior circulation specifically the lateral striate artery, the medial striate artery and the middle cerebral artery.…”

“…This corresponds to the brain region usually affected by stroke, specifically the basal ganglia and the internal capsule. 6,8 Sy et al 6 found that the frequency of poor outcomes among patients with TBM experiencing stroke was 51%, with a mortality rate of 21%. Thus, early initiation of appropriate therapy is crucial to improve prognosis.…”

“…Other therapeutic interventions to reduce the frequency of stroke in patients with TBM included steroids and antithrombotic therapy. 6,9 Rehabilitation programs are an effective way to prevent and reduce disabilities caused by severe illness, especially if they are started early in the course of the disease. When the rehabilitation program is started only after the infection is cured, it is more challenging to treat the disability that has already occurred.…”

Tuberculous Meningitis Complicated With Deep Sylvian Cerebral Infarction: About an Immunocompetent Patient With HIV-AIDS

“…The advanced stage of tuberculosis disease, basal and sylvian localization and visual impairment are among the predictive factors for the occurrence of stroke having been reported [5]. It is the cause of high morbidity and mortality with a life-threatening prognosis [14,15]. The functional prognosis will depend on the occurrence of neurological sequelae.…”

Review Article: Terapi Farmakologi Meningitis Tuberkulosis

“…Manifestasi klinis yang dirasakan oleh pasien dengan meningitis TB kebanyakan melibatkan sistem saraf pusat, sehinga akan mengalami sakit kepala secara terus menerus, demam, leher terasa kaku, batuk perkepanjangan, mual dan muntah. Dari sisi psikologis emosional juga menjadi cepat berubah yaitu gampang marah dan bingung, mengantuk, hingga pingsan (Sy et al, 2022).…”