A case of intracranial aneurysm and subarachnoid hemorrhage with tuberculous meningitis

A global increase in the incidence of tuberculosis has prompted the need for earlier diagnosis, treatment, and isolation of the disease. In tuberculosis, concomitant tuberculous meningitis and vascular complications such as intracranial aneurysms and subarachnoid hemorrhage are very rare. Because of the poor prognosis of tuberculous meningitis as well as intracranial aneurysm and subarachnoid hemorrhage, early diagnosis and management are crucial. We present the case of a 76-year-old woman who had two intracranial aneurysms complicated by subarachnoid hemorrhage, who had concomitant tuberculous meningitis. She remained well with medical management. Neurology Asia 2011; 16(2) : 157 – 161 Address correspondence to: Moon Ho Park, MD, PhD, Department of Neurology, Korea University Medical College, Korea University Ansan Hospital, Gojan1-dong, Danwon-gu, Ansan-city, Gyeonggi-do, South Korea. Tel: +82-31-412-5150, Fax: +82-31-412-5154, E-mail: [email protected] INTRODUCTION Globally, there were an estimated 9.27 million incident cases of tuberculosis in 2007, with most of these cases from Asia. Once infected, active disease develops in about 10% of cases, usually within 1 to 2 years after exposure. The remaining individuals enter a state of latency, which could reactivate at a later stage. Tuberculous meningitis (TBM), which is the most severe form of tuberculosis, has a high mortality and morbidity. Hydrocephalus and cerebral ischemia are commonly associated with TBM, while infectious intracranial aneurysms and subsequent subarachnoid hemorrhage (SAH) are rarely encountered. Infectious intracranial aneurysms, or mycotic aneurysms, are rare. The cerebrovascular lesions represent 0.7-5.4% of all intracranial aneurysms, and an aneurysm complicated by SAH could be a major factor contributing to a poor prognosis. Although a relationship between TBM and these vascular complications has been addressed in previous reports, there has been limited discussion regarding the possible relationship. We present a patient who had two intracranial aneurysms complicated by SAH that was presumed to be caused by TBM.