Abstract
A 32-year-old male with tuberculous meningitis with right tuberothalamic artery territory infarction was reported. The patient had a family history of pulmonary tuberculosis.
On 5th December 1988 he had fever, and headache on 10th. On 5th January 1989 he developed disorientation, confusional state and hypersomnia. When he was admitted to a local hospital on 4th February, he showed disorientation, fever and Kernig's sign. He was diagnosed of tuberculous meningitis because of 598/3 white blood cells, 170 mg/dl protein, 15 mg/dl glucose, 11.9 IU/1 adenosin deaminase, and positive culture of mycobacterium tuberculosis in cerebrospinal fluid. He was admitted to our hospital because of persistence of fever despite of therapy with INH and SM. On 7th February brain CT showed a low density area in the right tuberothalamic artery territory. And on 3rd March CT showed isodensities (increased attenuation) in the basal cisterns and Sylvian fissures, and marked enhancement in the same region. In MRI performed on 15th March, the arteries in basal cisterns were demonstrated as low intensity areas in Ti-& T2-weighted images due to flow void phenomenon. The Basal cisterns showed isointensities in Ti-weighted image, slight high intensities in T2-weighted image, and marked enhancement in Gd-enhancement. These lesions were considered as granulomas due to granulomatous basal arachnoiditis, and specific in tuberculous meningitis.
This patient had a right tuberothalamic artery territory infarction caused by tuberculous meningitis. This lesion was considered to cause disorientation, cofused state and hypersomnia. Cerebral angiography disclosed absence of the right P1 segment and that the thalamoperforating artery supplied only the left thalamus. It is necessary to consider a possibility of cerebral infarction when a patient with tuberculous meningitis has developed consciousness disturbance or mental disorder.
