Teaching neuroimages: a case of tubercular arteritis and stroke after early discontinuation of antibiotic therapy.

A 31-year-old man presented with acute left hemiplegia. History revealed a tuberculous pneumonia partially treated 10 months before, and headache and left leg jerks occurring recently. Upon examination, he was drowsy, with rightward gaze and head deviation and left hemiplegia. MRI showed an infarct on the right anterior and middle cerebral artery territory, leptomeningitis, and 2 tuberculomas (figure). Tests for HIV, syphilis, common bacteria, fungi, and viruses were negative. Despite antituberculosis therapy, he died after 37 days. Autopsy showed caseous necrosis, vasculitis, and confirmed tuberculosis diagnosis. Arteritis and infarctions are critical consequences of tuberculosis. Poor adherence to therapy exposes to disease relapse and drug resistance.