Intraventricular haemorrhage due to ruptured posterior inferior cerebellar artery aneurysm in tuberculous meningitis

Abstract

A 9-year-old Asian boy with known miliary tuberculosis, tuberculous meningitis and hydrocephalus was successfully treated with chemotherapy and ventriculoperitoneal shunting, but re-presented 7 months later with an intraventricular haemorrhage secondary to a ruptured left posterior inferior cerebellar artery mycotic aneurysm. The aneurysm was successfully treated by craniotomy and clipping. Tuberculous mycotic intracranial aneurysms are rare, but they should be considered in patients with tuberculous meningitis, particularly when there is a rapid neurological deterioration which may represent rupture.

Idiopathic Intraventricular Aneurysm Presenting with Intraventricular Hemorrhage: Case Report and Review of the Literature

“…Thalamostriate artery aneurysms usually project into the III ventricle. The vessels of origin of idiopathic IVA seem to be the same as those from which IVA in MMD arise [2,3,5,14,15,16,17,18,19]. …”

Haemorrhage in intracranial tuberculosis

“…[8][9][10][11][12][13][14][15][16] In terms of the latter it has been proposed (but to date not pathologically proven as far as we are aware) that the granuloma produces disintegration of a vessel wall with resultant haemorrhage. 13 Tuberculoma in association with an A-V fistula causing haemorrhage has also been described.…”

“…5,6 Intracranial haemorrhage as a complication of TBM has been described, albeit rarely. [8][9][10][11][12][13][14][15][16] There are a few case reports of patients with TBM complicated by intraventricular, intracerebral and subarachnoid haemorrhage on an aneurysmal or non-aneurysmal basis. [8][9][10][11][12][13][14][15][16] We describe here a patient with TBM and an associated left cerebellar tuberculoma who suddenly deteriorated and died on treatment.…”

“…[8][9][10][11][12][13][14][15][16] There are a few case reports of patients with TBM complicated by intraventricular, intracerebral and subarachnoid haemorrhage on an aneurysmal or non-aneurysmal basis. [8][9][10][11][12][13][14][15][16] We describe here a patient with TBM and an associated left cerebellar tuberculoma who suddenly deteriorated and died on treatment. A large haemorrhage involving the right cerebellum, with subarachnoid extension was demonstrated on computed tomography (CT) scan of the brain and at postmortem.…”

“…This has been reported previously. 15 The use of steroids in our patient to prevent or reduce the inflammatory response and the accompanying vasculitis is contentious. Had the patient been treated with steroids from the outset, is it possible that the disintegration of the internal elastic lamina by the inflammatory process would not have occurred and the consequent rupture with haemorrhage could have been prevented.…”