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Neurology
Stroke thrombolysis in tuberculous meningitis
  1. Pik Ee Chan1,
  2. Anamika Saha2,
  3. Tim Saunders2 and
  4. Gabriel SC Yiin3
  1. 1 Geriatric medicine, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
  2. 2 Great Western Hospital Foundation NHS Trust, Swindon, UK
  3. 3 Neurology Department, Singapore General Hospital, Singapore
  1. Correspondence to Dr Pik Ee Chan; chanpikee{at}gmail.com

Abstract

A woman in her 30s presented with sudden onset right-sided weakness, speech difficulties and transient loss of consciousness. She had a medical history of migraine, hypothyroidism and cervical lymphadenopathy. On examination, her National Institutes of Health Stroke Scale (NIHSS) score was 8 due to dense right-sided hemiparesis. CT brain imaging showed no intracranial haemorrhage but revealed incidental findings of left supraclavicular and cervical lymphadenopathy. CT intracranial angiogram did not show large vessel occlusion. She received thrombolytic treatment for ischaemic stroke. NIHSS improved to 3 with no immediate complications. Following admission, she developed swinging fever, seizures and fluctuating right-sided weakness. Repeat MRI of the head showed leptomeningeal enhancement. Biopsy of the cervical lymph nodes showed histiocytic granulomatous lymphadenitis, which was suggestive of tuberculous meningitis (TBM). She was treated with quadruple antimicrobial therapy and steroids for TBM, as well as aspirin for ischaemic stroke, which resulted in good clinical improvement.

  • TB and other respiratory infections
  • Meningitis
  • Stroke

https://doi.org/10.1136/bcr-2023-259376

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    Footnotes

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: PEC, AS, TS and GY. The following author gave final approval of the manuscript: GY. Guarantor is the PEC.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.