Abstracts

Background: Central Nervous system Tuberculosis is a serious infection commonly found to occur in the developing countries endemic to tuberculosis. It may manifest as meningitis, meningoencephalitis, tuberculoma, tubercular abscess, hydrocephalus, stroke due to tuberculous vasculitis and encephalopathy. Cerebral venous sinus thrombosis (CVT) is a type of cerebrovascular disease that occurs due to thrombosis of the intracranial veins and sinuses. Rarely, Tubercular meningitis (TBM) can predispose to cerebral venous sinus thrombosis (CVT). Here we report a young man, who initially presented as cerebral venous sinus thrombosis and was found to have Tubercular Meningitis.

Case: A 28-year-old male patient was admitted in Neurology department with complaints of high-grade continuous fever with diffuse headache and vomiting for 7 days prior to admission. On admission, patient was febrile, had stable vitals and was drowsy with occasionally responding to verbal commands. Cranial nerve examination was within normal limits except for the presence of bilateral early papilloedema. Neck stiffness was present along with positive Kernig sign. Rest of the neurological examination was within normal limits. Non contrast Computed tomography of Brain was suggestive of abnormal hyperdensity in the region of Superior sagittal sinus. Magnetic Resonance Venogram was suggestive of thrombosis of Superior sagittal sinus and right transverse sinus. CSF examination was suggestive of Tubercular Meningitis. Patient was started on antitubercular treatment and Low molecular weight heparin followed by oral anticoagulants. The patient responded to medications during hospitalisation, was discharged in a haemodynamically stable condition and was advised to continue oral anticoagulant for 6 months with regular INR monitoring along with antitubercular treatment and tapering dose of oral steroids.

Conclusion: Cerebral venous sinus thrombosis is a disease which can rarely be associated with tuberculous meningitis. A very high index of suspicion is required to correctly diagnose the complication as its timely aggressive treatment has an excellent outcome.