Magnetic resonance venographic findings in patients with tuberculous meningitis: Predictors and outcome

Bansod, Amrit; Garg, Ravindra Kumar; Rizvi, Imran; Malhotra, Hardeep Singh; Kumar, Neeraj; Jain, Amita; Verma, Rajesh; Kohli, Neera; Sharma, Praveen; Uniyal, Ravi; Pandey, Shweta

doi:10.1016/j.mri.2018.07.017

Cited by 16 publications

(9 citation statements)

References 27 publications

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“…12,31 Very little is known about venous involvement; a few factors such as stasis, endothelial inflammation and hypercoagulable state are considered to contribute to venous sinus thrombosis. [32][33][34] MRA abnormality presented in 43.2% of all TBM cases, which differs from prior studies, probably related to the imaging techniques used: DSA, CTA and MRA. 3,5,6,13,15 The MCA (84.4%) was the most common artery involved, followed by the ACA (42.3%) and ICA (34.6%), consistent with previous studies ( Table 6).…”

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confidence: 86%

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Cerebrovascular complications in tuberculous meningitis—A magnetic resonance imaging study in 90 patients from a tertiary care hospital

et al. 2019

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Background Cerebrovascular complications of tuberculous meningitis (TBM) are associated with increased morbidity and mortality. We retrospectively reviewed clinicoradiological findings of 90 TBM patients who presented to a tertiary care hospital, with emphasis on frequency and distribution of infarcts on diffusion imaging and pattern of vascular involvement on magnetic resonance (MR) angiography (MRA). Materials and methods MR images of 90 TBM patients at presentation (2012–2018) were coanalyzed by two radiologists for tuberculomas, leptomeningeal enhancement (LM), hydrocephalus, infarct and vascular abnormalities. Infarcts were categorized based on location (“tubercular” (TB) or “ischemic” zones) and arterial supply (perforators and cortical branches). Clinical and laboratory findings were correlated with imaging data. Results Ninety TBM patients (age 10–82 years) were enlisted after application of inclusion criteria. Tuberculomas were most common (100%) followed by LM (84.4%), cerebral infarcts (57.7%) and hydrocephalus (29%). Location-wise, 35% infarcts were in ischemic, 13% in TB and 15% in both zones. According to arterial supply, infarcts equally (50%) involved perforators from the lateral lenticulostriate and posterior cerebral (PCA)/basilar artery (BA) followed by medial lenticulostriate arteries (23%). MRA was available in 74.4% and abnormal in 43.2%. The middle cerebral artery was frequently involved (76%) followed by the anterior cerebral artery (38%), internal carotid artery (31%), PCA and BA. Six had diffuse narrowing with a paucity of distal vessels. Cerebral infarction was associated with hydrocephalus ( p = .0019) and vasculitis ( p < .001). Conclusion In TBM, strokes are common and mainly involve the perforators and cortical branches. MR is the imaging modality of choice for early diagnosis and timely management.

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confidence: 86%

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confidence: 99%

Cerebrovascular complications in tuberculous meningitis—A magnetic resonance imaging study in 90 patients from a tertiary care hospital

et al. 2019

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“… 13 14 15 In a large study by Bansod et al, abnormal MRV finding was noted in 12 (11.2%) out of 107 TBM patients. 16 In another study by Kalita et al, there was no evidence of venous thrombosis, although many variations in sinuses such as hypoplastic transverse sinus were seen. 8 Guenifi et al found 3 patients of CVST out of 61 patients of TBM.…”

Section: Discussionmentioning

confidence: 91%

Vascular Manifestations of Tuberculous Meningitis: MR Angiography and Venography Study

Naik

Bhoi

Deep

et al. 2022

JNRP

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Purpose The purpose of this study is to evaluate magnetic resonance (MR) angiography (MRA) and venography (MRV) findings in tuberculous meningitis (TBM). Methods Thirty consecutive patients of clinically diagnosed TBM were enrolled. Apart from T2-weighted imaging, T1-weighted imaging (T1WI), diffusion-weighted imaging, susceptibility-weighted imaging, fluid-attenuated inversion recovery, and postcontrast T1WI, time-of-flight (TOF) MRA and postcontrast MRV were done in all the patients. MRV was done after intravenous administration of gadolinium-based contrast agent followed by postcontrast T1WI. MRA and MRV findings were analyzed. Results Mean age of the patients was 33.13 ± 14.93 years. Duration of symptom was 34.90 ± 33.82 (range: 10–150) days. Out of 30 patients, 11 were categorized as definite TBM and 19 probable TBM. Eighteen (60%) were grade I, 7 (23%) grade II, and 5 (16%) grade III TBM based on severity. MR abnormalities were in varying combinations of leptomeningeal enhancement in 24 (80%), pachymeningeal in 2, both in 3, tuberculomas in 13 (43.3%), ventriculitis in 1, hydrocephalus in 16 (53.3%), and infarcts in 10 (33.3%) patients out of which the tubercular zone infarct in 9 patients. TOF MRA showed arterial abnormality in 13 patients. Anterior cerebral artery and middle cerebral artery have commonly involved vessels. Dural sinus thrombosis was noted in two patients. Both were female. One patient had subacute thrombus in the posterior part of superior sagittal sinus, left transverse sinus, and proximal right transverse sinus. The second patient had a filling defect in the transverse sinus. Conclusion In TBM, there is predominant arterial involvement causing infarcts which are usually seen in the tubercular zone. However, occasionally, there may be venous involvement causing cerebral venous sinus thrombosis.

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“…CVST can be caused by various disorders of hypercoagulable states, head trauma, intracranial procedures, brain tumors, abscess, and bacterial meningitis [ 12 ]. Since most CVST cases with TB occur as a complication of tuberculous meningitis [ 2 , 13 , 14 ], it may be possible that our patient suffered from tuberculosis meningitis. However, we could not perform a lumbar puncture for cerebrospinal fluid analysis because of the urgent need for anticoagulation therapy.…”

Section: Discussionmentioning

confidence: 99%

A Case of Tuberculosis-related Cerebral Venous Sinus Thrombosis and Pulmonary Thromboembolism Successfully Treated with Edoxaban

Nishino

Akimoto

Mitsuoka

et al. 2022

Respiratory Medicine Case Reports

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Magnetic resonance venographic findings in patients with tuberculous meningitis: Predictors and outcome

Cited by 16 publications

References 27 publications

Cerebrovascular complications in tuberculous meningitis—A magnetic resonance imaging study in 90 patients from a tertiary care hospital

Cerebrovascular complications in tuberculous meningitis—A magnetic resonance imaging study in 90 patients from a tertiary care hospital

Vascular Manifestations of Tuberculous Meningitis: MR Angiography and Venography Study

A Case of Tuberculosis-related Cerebral Venous Sinus Thrombosis and Pulmonary Thromboembolism Successfully Treated with Edoxaban

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