Evaluation of cerebral infarction in tuberculous meningitis by diffusion weighted imaging

• Published in: The Journal of infection Vol. 57; no. 4; pp. 298 - 306
• Main Authors: Shukla, Rakesh, Abbas, Asad, Kumar, Praveen, Gupta, Rakesh K, Jha, Sanjeev, Prasad, K.N
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01-10-2008; Elsevier
• Subjects: Adolescent; Adult; Bacterial diseases; Bacterial diseases of the nervous system. Bacterial myositis; Biological and medical sciences; Cerebral Infarction - diagnosis; Cerebral Infarction - pathology; Complications of TBM; Diffusion Magnetic Resonance Imaging - methods; Diffusion weighted imaging; Female; General aspects; Human bacterial diseases; Humans; Infarct; Infectious Disease; Infectious diseases; Magnetic Resonance Imaging; Medical sciences; Middle Aged; Neurology; Radiography; Tuberculosis, Meningeal - complications; Tuberculosis, Meningeal - diagnostic imaging; Tuberculous meningitis; Vascular diseases and vascular malformations of the nervous system; Young Adult; NEX; ADC; ATT; Infarct; time to repetition; fast spin echo; acid fast bacilli; Tuberculous meningitis; DWI; FSE; MTSE; TBM; middle cerebral artery; Complications of TBM; central nervous system; echo planar imaging; time to echo; cerebrospinal fluid; Medical Research Council; human immunodeficiency virus; AFB; MRA; PCR; MRC; ELISA; MRI; CNS; enzyme linked immunosorbent assay; apparent diffusion coefficient; CSF; FLAIR; polymerase chain reaction; computed tomography; MCA; anti tuberculous treatment; CT; APTT; TE; number of excitations; Magnetic resonance imaging; HIV; activated partial thromboplastin time; fluid attenuated inversion recovery; echo train length; magnetization transfer spin echo; ETL; Diffusion weighted imaging; magnetic resonance angiography; TR; EPI; Cerebral infarction; Nervous system diseases; Diffusion imaging; Cardiovascular disease; Mycobacterial infection; Cerebral disorder; Vascular disease; Infection; Tuberculosis; Central nervous system disease; Bacteriosis; Cerebrovascular disease
• ISSN: 0163-4453; 1532-2742
• DOI: 10.1016/j.jinf.2008.07.012

Summary Background Ischemic complications are known to occur in tuberculous meningitis (TBM). They are usually seen in patients with TBM having a more severe disease. Diffusion weighted imaging (DWI) provides information regarding tissue ischemia at an early stage as compared to conventional magnetic resonance imaging (MRI). Methods Ischemic complications in human immunodeficiency virus (HIV) negative TBM were evaluated using DWI and T2 weighted imaging in 30 patients in the present study. The imaging was performed at baseline within 7 days of admission and in case of any neurological deterioration during follow up. The outcome was assessed by the modified Barthel's index at 1 year follow up. A score of ≥12 was taken as a poor outcome, while a score of <12 was considered as good outcome. Result Seventeen of these 30 patients had infarcts, and the total number of infarcts seen was 42. Thirty eight lesions were acute/sub acute and four were chronic infarcts. Out of the 38 acute/sub acute infarcts 34 were visible both on T2 weighted imaging and on DWI, while four were seen only on DWI. The volume of infarcts as seen by DWI was significantly larger as compared to conventional T2 weighted imaging ( p = 0.019). Six patients had a poor outcome, five from the infarct group and one from the non-infarct group. Conclusion DWI demonstrates a larger area of infarction and may also be useful in the early detection of infarction. It should be used as an additional sequence along with conventional imaging in patients with TBM while they are on a follow up on anti tuberculous treatment. The information obtained by DWI may be of value in explaining the clinical condition of the patient as well as in the management and prognostication.