Background : Cerebral infarcts often complicate tuberculous meningitis (TBM), which usually result from small-artery occlusion. However, infarcts in the large-artery territory are uncommon, and isolated anterior cerebral artery (ACA) infarct has not been reported.
Case Description : Patient 1, a 28-year-old man, was admitted with right hemiparesis worse on the leg. Brain MRI and cerebral angiography showed left ACA territory infarct and occlusion of left ACA. Patient 2, a 26-year-old man, presented with akinetic mutism. Angiography demonstrated occlusion and narrowing of multiple intracranial arteries including both ACAs. Heart disease, systemic vasculitis,and other risk factors of stroke were completely excluded in both patients. Diagnosis of TBM was supported by CSF study, brain MRI, chest X-ray, or biopsy. Recovery was fair in patient 1 with unilateral infarct, whereas patient 2 with bilateral infarct showed grave outcome despite adequate therapy.
Conclusion : TBM may be considered a potential cause of intracranial large-artery occlusive disease.
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