Hemichorea in tuberculous meningitis

Abstract

We report on a 14 y/o HIV-negative girl with diagnosis of miliary tuberculosis (meningitis and pulmonary disease) who presented with right hemichorea three weeks after initiation of prednisone, rifampin, isoniazide, pyrazinamide and ethambutol. Brain MRI showed ischemic lesions in left caudate and lenticulo-capsular area (Figure). Hemichorea is a rare neurological manifestation of tuberculosis 1. Basal ganglia infarcts caused by vasculitis probably decreased the GABAergic transmission in indirect basal ganglion pathway causing hemichorea. The major differential diagnoses in acquired hemichorea are Sydenham's chorea, nonketotic hyperglycemia and cerebral toxoplasmosis 2. We emphasize the importance of brain MRI in the diagnostic evaluation of these patients.

Dancing Out of Step: A Case of Tuberculous Meningitis Presenting as Childhood Chorea

“…The prevalence of MDs among patients with TBM range from 0.5 to 18.6%. The higher the BMRC grade, the greater is one's predisposition to develop movement abnormalities [10][11][12]. Cases manifesting with parkinsonism, tremors, dystonia, myoclonus, chorea, or hemiballismus had been documented and tremor was noted to be the most common phenomenology [4,6].…”

Review of Hereditary and Acquired Rare Choreas

“…Bacterial Some of the reported uncommon bacterial causes of chorea include typhoid fever [136], pertussis, diphtheria, Legion naires' disease [137], tuberculous meningitis [138,139], and mycoplasma [140]. The mechanism is suggested to be related to a cytotoxic effect of bacteria [137].…”