[Tuberculosis and stroke: case report and literature review]

Abstract

Tuberculosis remains a public health problem in Côte-d'Ivoire, a sub-saharan region country, where infection with a prevalence of 2-10% increase tuberculosis incidence assesed to 290 per 100,000 habitants. Authors report a case of a ischemic stroke (IS) and unknown HIV and tuberculosis infection; discuss these infections responsibility in the occurrence of this IS and past neurological signs. The patient presented with a left hemiparesis without infectious sign nor drowsiness. Medical history noticed a weight loss and two months ago a completely regressive tetraparesia. CT cerebral scan didn't found other sign than a IS located in the right middle cerebral artery territory as describe in the literature. The cerebrospinal fluid (CS) blood cell count was high and Mycobacterium tuberculosis (MT) was found at direct exam. Positive HIV blood serology and MT where noticed at direct spit smears without chest radiograph lesion. After MT six month treatment progresses was good with no MT in CS and spit smears. Because of financial problems HIV treatment was unitialized at this time and MT was prolonged to 12 months. Literature point out different forms sometimes associated of intracranial tuberculosis (meningitis, hydrocephalus, tuberculoma, milliary, abscess, empyema). MT at direct exam was scarce, in spite of news biological methods MT diagnosis can be difficult and need a biopsy or a test treatment. Arachnoid's enhancement is frequent but MT can be misdiagnosed by CT scan which is sometimes less efficient than IRM.

Conclusion: This case argue that tuberculosis may be evocated as a stroke aetiology especially in presence of HIV infection even if some cardiovascular risk factors are present.