Neuropediatrics 2010; 41(6): 273-275
DOI: 10.1055/s-0031-1273706
Short Communications

© Georg Thieme Verlag KG Stuttgart · New York

Febrile Brain Stroke and Tuberculous Meningitis: Persisting Threat in Non-Endemic Countries

K. Deiva1 , 2 , S. Sothratanak1 , B. Husson3 , L. Chevret4 , P. Landrieu1
  • 1Pediatric Neurology Department, AP-HP, Bicêtre Hospital, Le Kremlin Bicêtre, France
  • 2National Reference Center for Neuro-Inflammatory Diseases in Children, AP-HP, Bicêtre Hospital, Le Kremlin Bicêtre, France
  • 3Pediatric Radiology Department, AP-HP, Bicêtre Hospital, Le Kremlin Bicêtre, France
  • 4Pediatric Resuscitation Department, AP-HP, Bicêtre Hospital, Le Kremlin Bicêtre, France
Further Information

Publication History

received 21.11.2010

accepted 09.02.2011

Publication Date:
28 March 2011 (online)

Abstract

Tuberculous meningitis is uncommon in western countries and its outcome is poor when it is not diagnosed and treated in good time. Here, we present a case of febrile brain stroke revealing a tuberculous arachnoiditis in a 13-month-old infant living in a non-endemic country. Thanks to prompt specific antibiotherapy, the clinical outcome was globally favourable in spite of the occurrence of an asymptomatic brain tuberculoma, which disappeared spontaneously. Although tuberculous meningitis is rare in non-endemic countries, it must be evoked in strokes occurring in a febrile context.

References

  • 1 Bonafe A, Manelfe C, Gomez MC. et al . Tuberculous meningitis. Contribution of computerized tomography to its diagnosis and prognosis.  J Neuroradiol. 1985;  12 302-316
  • 2 Cheng VC, Yam WC, Woo PC. et al . Risk factors for development of paradoxical response during antituberculosis therapy in HIV-negative patients.  Eur J Clin Microbiol Infect Dis. 2003;  22 597-602
  • 3 Dastur DK, Dave UP. Further observations of the fine structure of blood vessels in neurotuberculosis: possible significance of vasculitis with proliferated basement membrane.  Adv Neurol. 1978;  20 577-589
  • 4 Dastur DK, Lalitha VS, Udani PM. et al . The brain and meninges in tuberculous meningitis-gross pathology in 100 cases and pathogenesis.  Neurol India. 1970;  18 86-100
  • 5 Delphine Antoine DC. Epidémiologie de la tuberculose en France: bilan des cas déclarés en 2008.  Bulletin Epidemiologique Hebdomadaire. 2010;  27–28 289-293
  • 6 Grare M, Derelle J, Dailloux M. et al . QuantiFERON-TB Gold In-Tube as help for the diagnosis of tuberculosis in a French pediatric hospital.  Diagn Microbiol Infect Dis. 2010;  66 366-372
  • 7 Ira S. Paradoxical appearance of intracranial tuberculoma in a child with tuberculous meningitis.  J Trop Pediatr. 2005;  51 191-193
  • 8 Kalita J, Misra UK. Outcome of tuberculous meningitis at 6 and 12 months: a multiple regression analysis.  Int J Tuberc Lung Dis. 1999;  3 261-265
  • 9 Kalita J, Misra UK, Nair PP. Predictors of stroke and its significance in the outcome of tuberculous meningitis.  J Stroke Cerebrovasc Dis. 2009;  18 251-258
  • 10 Kingsley DP, Hendrickse WA, Kendall BE. et al . Tuberculous meningitis: role of CT in management and prognosis.  J Neurol Neurosurg Psychiatry. 1987;  50 30-36
  • 11 Kumar R, Prakash M, Jha S. Paradoxical response to chemotherapy in neurotuberculosis.  Pediatr Neurosurg. 2006;  42 214-222
  • 12 Lammie GA, Hewlett RH, Schoeman JF. et al . Tuberculous cerebrovascular disease: a review.  J Infect. 2009;  59 156-166
  • 13 Nicolls DJ, King M, Holland D. et al . Intracranial tuberculomas developing while on therapy for pulmonary tuberculosis.  Lancet Infect Dis. 2005;  5 795-801
  • 14 Poonnoose SI, Rajshekhar V. Rate of resolution of histologically verified intracranial tuberculomas.  Neurosurgery. 2003;  53 873-878 discussion 878–879
  • 15 Prasad K, Singh MB. Corticosteroids for managing tuberculous meningitis.  Cochrane Database Syst Rev. 2008;  CD002244
  • 16 Schoeman J, Mansvelt E, Springer P. et al . Coagulant and fibrinolytic status in tuberculous meningitis.  Pediatr Infect Dis J. 2007;  26 428-431
  • 17 Sheu JJ, Hsu CY, Yuan RY. et al . Clinical characteristics and treatment delay of cerebral infarction in tuberculous meningitis.  Intern Med J. 2010;  May 11 epub ahead of print
  • 18 Thwaites G, Fisher M, Hemingway C. et al . British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children.  J Infect. 2009;  59 167-187
  • 19 van Woensel JB, Hoogeveen CG, Begeer JH. et al . Intracranial tuberculosis in The Netherlands: four paediatric cases.  Eur J Pediatr. 1995;  154 546-550

Correspondence

Dr. Kumaran Deiva

Pediatric Neurology

Department

National Reference Center for

Neuro-Infl ammatory Diseases

in Children

Bicêtre Hospital

78 rue G Leclerc

94275 Le Kremlin Bicêtre

France

Phone: +33/01/4521 3158

Fax: +33/01/4521 3231

Email: kumaran.deiva@bct.aphp.fr

    >