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Year : 2021  |  Volume : 10  |  Issue : 3  |  Page : 228-233

Evaluation of intracranial vasculitis in tuberculous meningitis using magnetic resonance vessel wall imaging technique

1 Department of Radiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
2 Department of Medicine, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
3 Department of Infectious Diseases, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
4 Department of Medicine, St. Vincent Hospital, Worcester, MA, USA
5 Department of Radiology, Jerudong Park Medical Center, Bandar Seri Begawan, Brunei

Correspondence Address:
Harshad Arvind Vanjare
Department of Radiology, Christian Medical College and Hospital, Ida Scudder Road, Vellore - 632 004, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijmy.ijmy_117_21

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Background: Tuberculous meningitis (TBM) is a global health problem with important complications such as acute infarcts secondary to vasculitis contributing to adverse outcomes. The objective of this study is to assess intracranial vasculitis in patients with TBM, either during their initial diagnosis or during follow-up while on standard antituberculous therapy. Methods: Ten patients with TBM underwent magnetic resonance (MR) based vessel wall imaging (VWI) to identify intracranial vasculitis (five patients during their initial presentation and the other five patients during their follow-up visit). Results: Vasculitis was seen in 60% of the patients wherein 70% of their intracranial vessels were affected. Acute and chronic infarcts were seen in four and two patients respectively, one of whom had both acute and chronic infarcts. Leptomeningeal enhancement and basal cisternal tuberculomas were frequently seen in patients with vasculitis. Vasculitis was also seen many days after the commencement of the antituberculous therapy thus explaining late-onset infarcts in this disease. Conclusion: Intracranial vasculitis is common in the patient with TBM. MR-based VWI technique has the potential for infarct risk assessment and to help guide the treatment for its possible prevention.

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