Risk assessment of the outcome for cerebral infarction in tuberculous meningitis

Chen, C.-H.; Chang, Yu-Jun; Sy, Hiu-Ngar; Chen, W.L.; Yen, Hua-Cheg

doi:10.1016/j.neurol.2014.06.004

Cited by 17 publications

(11 citation statements)

References 41 publications

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“…In clinical presentations, fever and headache are the most common symptoms in TBM patients, which were also confirmed in our young TBM patients [8, 10, 13]. Altered consciousness has been reported about 17–69% in TBM patients, which was 32.7% in our study [8, 10, 13].…”

Section: Discussionsupporting

confidence: 87%

“…Altered consciousness has been reported about 17–69% in TBM patients, which was 32.7% in our study [8, 10, 13]. TBM patients with stroke were more likely to have focal weakness [8, 10]. We found that 41.7% patients in stroke group had focal weakness, which was 17.5% in non-stroke group.…”

Section: Discussionsupporting

confidence: 60%

“…Stroke is a common complication of TBM patients, which can cause irreversible brain damage [2]. Results from many studies have demonstrated that stroke predict poor clinical outcome, which may be disastrous consequence for young TBM patients [1, 8–10]. However, risk factors of stroke in young TBM patients were not fully understood.…”

Section: Discussionmentioning

confidence: 99%

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Acute ischemic stroke in young adults with tuberculous meningitis

Li-ming

Zhang

Li³

et al. 2019

BMC Infect Dis

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Background Ischemic stroke is a common complication in patients with tuberculous meningitis (TBM), which is associated with poor clinical outcome. However, risk factors of stroke in TBM patients were not fully understood, especially in those young adults. Therefore, the aim of our study was to identify risk factors for acute ischemic stroke in young adults with TBM. Methods TBM patients (18 to 50 years) without cerebral vascular risk factors were prospective recruited between Feb 2014 and Dec 2017. Patients were defined as stroke group and non-stroke group by brain magnetic resonance imaging (MRI). Demographic characteristics, clinical presentations, cerebrospinal fluid (CSF) examination, basal meningeal enhancement, hydrocephalus, tuberculoma and clinical outcome were compared between two groups. Binary logistic regression was performed to determine risk factors for acute ischemic stroke in young TBM patients. Results Fifty-two patients with TBM were included and 12 (23.1%) patients were in stroke group. Patients in stroke group were older. Clinical presentations were comparable between two groups except headache was more common in TBM patients with stroke. In CSF examination, TBM patients with stroke had higher CSF white blood cell. By MRI, patients in stroke group were more likely to have basal meningeal enhancement but less likely to present tuberculoma. Compared to non-stroke group, patients in stroke group had worse short-term clinical outcome. In logistic regression, age (OR = 1.297; 95%CI 1.067, 1.576), CSF white blood cell (OR = 1.023; 95%CI 1.005, 1.042) and basal meningeal enhancement (OR = 23.913; 95%CI 1.398, 408.975) were independent risk factors for stroke. However, tuberculoma (OR = 0.005; 95%CI 0.000, 0.254) was negative related with stroke. Conclusions About a quarter of young adults with TBM have acute ischemic stroke which may lead to poor clinical outcome. Age, CSF white blood cell and basal meningeal enhancement are risk factors for acute ischemic stroke in young adults with TBM.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 60%

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Acute ischemic stroke in young adults with tuberculous meningitis

Li-ming

Zhang

Li³

et al. 2019

BMC Infect Dis

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“…Meanwhile its major complication is cerebral infarction and disability (9,12). To diagnose TBM, clinical presentation, imaging, and laboratory data are essential (8).…”

Section: Discussionmentioning

confidence: 99%

Serial Polymorphonuclear Predominance of Cerebrospinal Fluid in a Child with Advanced Tuberculous Meningitis: A Case Report

Hosamirudsari

Afsari

Etesam

2017

Iran Red Crescent Med J

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Introduction: Tuberculous meningitis (TBM) is the most fatal form of tuberculosis. Despite adequate treatment, its mortality and morbidity is high. Clinical, laboratory, and radiologic findings help in diagnosis of TBM, although analysis of cerebrospinal fluid (CFS) might sometimes delay and mislead the rapid diagnosis. Case Presentation: We present a 14-year-old Afghan immigrant male, with uncommon laboratory results of advanced TBM, who referred to Baharloo hospial in Tehran, Iran, in September 2016. He experienced headache and anxiety one month prior to referring to the hospital; he had fever, severe headache, vomiting and showed bizarre behavior 7 days before admission. Suspecting meningoencephalitis, the physician advised empirical treatment. The first CSF revealed polymorphonuclear (PMN) predominance with low glucose, which was repeated in the second and third CSF analysis. This pattern indicates early phase of TB meningitis. In day 4, antituberculous treatment with corticosteroid was administered empirically. Unfortunately, he succumbed to disease in day 36. Polymerase chain reaction (PCR) for mycobacterium tuberculosis (MTB) in CSF was positive. The patient's presentation (lethargic to coma) and brain computed tomography (CT) scan indicated advanced stage of disease. Conclusions: All physicians should consider TB meningitis in any patient with low glucose even with serial PMN predominance in CSF.

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“…[1] CI, commonly in the older population, is the most common cause of disability as well as the second leading cause of mortality in the world. [23] Apart from its complex clinical manifestations, CI is correlated with unfavorable outcomes that pose a heavy long-term burden on the society in terms of health-care costs and patient care; a previous study revealed that multiple physiopathological parameters, such as inflammation, necrosis, apoptosis, oxidative stress, hypercoagulable state, and vascular dysfunction, could be applied to evaluate CI pathogenesis. [4] Notably, despite the identification of some of the major risk factors for CI, including advancing age, low cerebrospinal fluid (CSF), white blood cell count, and systemic inflammation,[56] effective prevention and therapeutic interventions for CI are currently not available due to the complexity of the disease and lack of reliable biomarkers for early detection.…”

Section: Introductionmentioning

confidence: 99%

Serum leptin levels may be correlated with cerebral infarction

Yao

Sun

et al. 2016

J Res Med Sci

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Background:To investigate the relation between serum leptin levels and cerebral infarction (CI) by meta-analysis.Materials and Methods:Scientific literature databases were searched for studies published in Chinese and English. After retrieving relevant articles through database searches and screening using predefined selection criteria, high-quality studies related to our research topic were selected for inclusion in this meta-analysis. All statistical analyses were conducted using Comprehensive Meta-Analysis 2.0 (CMA 2.0, Biostat Inc., Englewood, New Jersey, USA).Results:The study results revealed that serum leptin levels were significantly higher in CI patients as compared to normal controls. The outcomes of subgroup analysis by ethnicity suggested that the serum leptin levels in CI patients were significantly higher than normal controls in both Asian and Caucasian populations. Further, subgroup analysis based on the detection method indicated that the serum leptin levels in CI patients were significantly higher compared with normal controls when measured by radioimmunoassay (RIA) but enzyme-linked immunosorbent assay (ELISA)-based measurements did not show such statistically significant differences.Conclusion:Our meta-analysis results suggest that serum leptin levels in CI patients may be closely correlated with CI risks.

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Risk assessment of the outcome for cerebral infarction in tuberculous meningitis

Cited by 17 publications

References 41 publications

Acute ischemic stroke in young adults with tuberculous meningitis

Acute ischemic stroke in young adults with tuberculous meningitis

Serial Polymorphonuclear Predominance of Cerebrospinal Fluid in a Child with Advanced Tuberculous Meningitis: A Case Report

Serum leptin levels may be correlated with cerebral infarction

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