Computed tomography angiography in patients with tuberculous meningitis

Background: Strokes in tuberculous meningitis are important determinant of prognosis. Strokes are caused by tuberculosis-related vasculopathy. In this study, we aimed to demonstrate the value of computed tomography angiography. We also assessed value of angiographic findings in determining the prognosis.

Methods: We included consecutive patients of tuberculous meningitis and prospectively followed them for 6 months. Computed tomography angiography was performed at inclusion. Follow-up angiography, after 6 months, was done in the patients, who had given consent. Angiographic findings were evaluated by experienced neuroradiologists.

Results: Initial computed tomography angiography revealed arterial narrowing or occlusion in 33 patients. In 30 patients the anterior cerebral circulation and in 9 patients posterior cerebral circulation was involved. Six (18.2%) patients had lesions in both the territories. The most frequently involved arteries were supraclinoid portion of the internal carotid artery, and proximal portions of the anterior cerebral and middle cerebral arteries. On univariate analysis, predictors of angiographic abnormalities were impaired vision (p = 0.019), hemiparesis (p = 0.002), hydrocephalous (p < 0.001), basal exudates (p < 0.001), meningeal enhancement (p = 0.026) and infarcts (p < 0.001). On multivariate analysis basal exudates was a significant predictor. Angiographic abnormalities were associated with insignificantly poorer prognosis. On follow-up angiograms, 3 patients showed resolution in vascular abnormalities. Two patients had developed new angiographic abnormalities.

Conclusion: Arterial narrowing and occlusion is seen in majority of patients with tuberculous meningitis. Angiographic abnormalities may be associated with poor prognosis.