Cerebral hemorrhage due to tuberculosis meningitis: a rare case report and literature review

// Hai Zou 1,* , Ke-Hua Pan 2,* , Hong-Ying Pan 1,* , Dong-Sheng Huang 3 and Ming-Hua Zheng 4,5 1 Department of Infection Diseases, Zhejiang Provincial People’s Hospital, Hangzhou, China 2 Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China 3 Department of Hepatobiliary Surgery, Zhejiang Provincial People’s Hospital, Hangzhou, China 4 Department of Infection and Liver Diseases, Liver Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China 5 Institute of Hepatology, Wenzhou Medical University, Wenzhou, China * Co-first author Correspondence to: Ming-Hua Zheng, email: // Dong-Sheng Huang, email: // Keywords : intracerebral hemorrhage; leptomeningeal enhancement; tuberculosis meningitis; central nervous system Received : October 13, 2015 Accepted : December 02, 2015 Published : December 10, 2015 Abstract Tuberculosis (TB) is a common disease to threaten human health. TB of the central nervous system (CNS) is rare but the most serious type of systemic TB because of its high mortality rate, serious neurological complications and sequelae. In this case report, we describe a woman who presented with walking instability, intracerebral hemorrhage and leptomeningeal enhancement due to tuberculosis meningitis. The patient had no significant medical history and the initial clinical symptoms were walking instability. On analysis, the cerebrospinal fluid was colorless and transparent, the pressure was more than 400 mm H 2 O, there was lymphocytic pleocytosis, increased protein, and decreased glucose levels present. No tuberculosis or other bacteria were detected. The patient’s brain computed tomography image showed intra-cerebral hemorrhage (ICH) and contrast magnetic resonance imaging showed ICH in the right frontal lob, and leptomeningeal enhancement. CNS TB is rare but has a high mortality rate. As this disease has no unique characteristics at first presentation such as epidemiology and obvious clinical manifestation, a diagnosis of CNS TB remains difficult.