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Conference Paper: Cerebral infarction complicating Tuberculous Meningitis (TBM)

TitleCerebral infarction complicating Tuberculous Meningitis (TBM)
Authors
Issue Date2004
PublisherHong Kong Medical Association. The Journal's web site is located at http://www.hkmj.org
Citation
The 17th Annual Scientific Meeting of the Hong Kong Neurological Society, Hong Kong, 13-14 November 2004. In Hong Kong Medical Journal, 2004 v. 10 suppl. 2, p. 8, abstract no. F3 How to Cite?
AbstractBACKGROUND: Cerebral infarction (CI) is a serious complication of TBM, which can be silent (silent CI) or symptomatic causing stroke (symptomatic CI). Data of topographical distribution and prognosis of CI complicating TBM are limited. The best treatments and preventive measures are unknown. METHODS: TBM patients managed from January 1997 to June 2003 were prospectively studied. Treatments were standard anti-TB regimens, and corticosteroids for stage 2 and 3 TBM. Initial CT brain was performed in all patients. Reassessment CT/MRI brain was performed at 3 months of therapy and for neurological deterioration or complications. Lacunar infarction (LI) was defined as subcortical, cerebellar or brainstem infarction with a diameter of 15 mm or less on CT/MRI. Large-artery infarction (LAI) was defined as a lesion >15 mm in diameter on CT/ MRI. Modified Barthel index (BI) < 12 at 1 year of therapy or mortality were criteria for poor outcome. Clinical features of patients with LI only and those with LAI were compared with Student’s t-test and Fisher’s exact test. RESULTS: Forty TBM patients were studied. Twelve (30%) had CI, 9 (23%) were symptomatic and 3 (8%) were silent. Age of the 12 patients with CI ranged from 18-85 years, 8 were men. Two had stroke at onset of TBM, and 7 had symptoms of meningitis before development of stroke after a mean interval of 40 days (range 0-128 days). Four (33%) patients had single CI while 8 (67%) had multiple CI. Five (42%) had LI only while 7 (58%) had LAI with or without coexisting LI. Eight (67%) had CI restricted to anterior circulation territory while 1 (8%) had posterior circulation CI only; 3 (25%) had both anterior and posterior circulation CI. Two patient died, both from extensive posterior circulation CI and 6 (50%) had BI < 12 at 1 year. Hence 8 (67%) patients had poor neurological outcome. There is no significant difference in clinical features between those with LI only and those with LAI, but patients with LAI might have increased risk of developing posterior circulation CI. CONCLUSION: CI is a common complication of local TBM patients (30%, symptomatic in 23%) which tends to be multiple with LAI being common. About two-thirds of these TBM patients had poor neurological outcome at 1 year.
DescriptionFree Paper Presentations
Persistent Identifierhttp://hdl.handle.net/10722/101146
ISSN
2015 Impact Factor: 0.887
2015 SCImago Journal Rankings: 0.279

 

DC FieldValueLanguage
dc.contributor.authorChan, KHen_HK
dc.contributor.authorCheung, RTFen_HK
dc.contributor.authorLee, Ren_HK
dc.contributor.authorMak, Wen_HK
dc.contributor.authorCheng, TSen_HK
dc.contributor.authorHo, SLen_HK
dc.date.accessioned2010-09-25T19:37:48Z-
dc.date.available2010-09-25T19:37:48Z-
dc.date.issued2004en_HK
dc.identifier.citationThe 17th Annual Scientific Meeting of the Hong Kong Neurological Society, Hong Kong, 13-14 November 2004. In Hong Kong Medical Journal, 2004 v. 10 suppl. 2, p. 8, abstract no. F3en_HK
dc.identifier.issn1024-2708en_HK
dc.identifier.urihttp://hdl.handle.net/10722/101146-
dc.descriptionFree Paper Presentations-
dc.description.abstractBACKGROUND: Cerebral infarction (CI) is a serious complication of TBM, which can be silent (silent CI) or symptomatic causing stroke (symptomatic CI). Data of topographical distribution and prognosis of CI complicating TBM are limited. The best treatments and preventive measures are unknown. METHODS: TBM patients managed from January 1997 to June 2003 were prospectively studied. Treatments were standard anti-TB regimens, and corticosteroids for stage 2 and 3 TBM. Initial CT brain was performed in all patients. Reassessment CT/MRI brain was performed at 3 months of therapy and for neurological deterioration or complications. Lacunar infarction (LI) was defined as subcortical, cerebellar or brainstem infarction with a diameter of 15 mm or less on CT/MRI. Large-artery infarction (LAI) was defined as a lesion >15 mm in diameter on CT/ MRI. Modified Barthel index (BI) < 12 at 1 year of therapy or mortality were criteria for poor outcome. Clinical features of patients with LI only and those with LAI were compared with Student’s t-test and Fisher’s exact test. RESULTS: Forty TBM patients were studied. Twelve (30%) had CI, 9 (23%) were symptomatic and 3 (8%) were silent. Age of the 12 patients with CI ranged from 18-85 years, 8 were men. Two had stroke at onset of TBM, and 7 had symptoms of meningitis before development of stroke after a mean interval of 40 days (range 0-128 days). Four (33%) patients had single CI while 8 (67%) had multiple CI. Five (42%) had LI only while 7 (58%) had LAI with or without coexisting LI. Eight (67%) had CI restricted to anterior circulation territory while 1 (8%) had posterior circulation CI only; 3 (25%) had both anterior and posterior circulation CI. Two patient died, both from extensive posterior circulation CI and 6 (50%) had BI < 12 at 1 year. Hence 8 (67%) patients had poor neurological outcome. There is no significant difference in clinical features between those with LI only and those with LAI, but patients with LAI might have increased risk of developing posterior circulation CI. CONCLUSION: CI is a common complication of local TBM patients (30%, symptomatic in 23%) which tends to be multiple with LAI being common. About two-thirds of these TBM patients had poor neurological outcome at 1 year.-
dc.languageengen_HK
dc.publisherHong Kong Medical Association. The Journal's web site is located at http://www.hkmj.orgen_HK
dc.relation.ispartofHong Kong Medical Journalen_HK
dc.rightsHong Kong Medical Journal. Copyright © Hong Kong Medical Association.en_HK
dc.titleCerebral infarction complicating Tuberculous Meningitis (TBM)en_HK
dc.typeConference_Paperen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=1024-2708&volume=10&issue=Suppl 2&spage=8&epage=&date=2004&atitle=Cerebral+infarction+complicating+tuberculous+meningitis.+en_HK
dc.identifier.emailCheung, RTF: rtcheung@hku.hken_HK
dc.identifier.emailHo, SL: slho@hku.hken_HK
dc.identifier.authorityCheung, RTF=rp00434en_HK
dc.identifier.hkuros99234en_HK
dc.identifier.hkuros143705-
dc.identifier.volume10en_HK
dc.identifier.issuesuppl 2en_HK
dc.identifier.spage8, abstract no. F3en_HK
dc.identifier.epage8, abstract no. F3-

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