Intracranial Aneurysm In a Case of Tubercular Meningoencephalitis, a Rare Presentation
Kuntal Biswas1, Debarup Das3, Venkata Sriram Chintha2, Bhaswar Bhattacharya2, Atanu Biswas4, Uddalak Chakraborty5
1NEUROLOGY, 2Neurology, BANGUR INSTITUTE OF NEUROSCIENCES,IPGMER, 3Neurology, Bangur Institute of Neurology, 4Neurology, Bangur Institute of Neurosciences, 5Neurology, Bangur Institute of Neurosciences, IPGMER & SSKM Hospital Annex 1
Background:
In this era of advanced medical science and technology, tuberculosis remains as a major health problem in developing countries like India. While pulmonary TB is the most common manifestation of TB, incidence of extrapulmonary TB is also gradually increasing. Affliction of central nervous system is considered one of the most severe forms of extrapulmonary tuberculosis. Central nervous system (CNS) tuberculosis(TB) comprises 15%–20% of the total cases of extra-pulmonary TB and it is associated with a high mortality rate. Surprisingly a little less than 5% of patients with pulmonary TB develop CNS TB and not all patients with CNS TB have pulmonary TB.
Although CNS involvement by tuberculosis is seen in all age groups, there is a predilection for younger and immunocompromised patients. Central nervous system tuberculosis may present as tubercular meningitis, meningoencephalitis , tuberculoma, tubercular abscess. Vasculitis , secondary to TBM can cause infarcts commonly but development of an intracranial tuberculous aneurysm is a rare complication.
Results:
Case Report:
A 33-year-old male presented with a low grade fever, meningism for weeks, diagnosed to have tubercular meningoencephalitis after supportive brain imaging and CSF assay. During course of hospitalization developed left ptosis, binocular horizontal diplopia, dimness of vision of left eye with diminished left periorbital sensation suggestive of a left anterior cavernous sinus syndrome. Brain imaging with angiogram of cerebral vasculature revealed an aneurysm at left ICA-MCA junction, probably a sequalae of granulomatous vasculitis
Conclusions:
Discussion:
This case report shows an unusual case of intracranial tuberculomas complicated by intralesional haemorrhage due to an infective tubercular aneurysm. During disease course, MTB may colonize the arterial wall and erode its entire thickness with caseating necrosis, forming an aneurysm. These aneurysms are prone to rupture with fatal complications. Early identification of the disease with proper treatment is critical for the prevention of fatal complications.