Tuberc Respir Dis.  2001 Dec;51(6):603-608. 10.4046/trd.2001.51.6.603.

A Case of Tuberculous Meningoencephalitis Presenting as Prominent Psychotic Features

• Yu HJ
• Oh JY
• Kim JH
• Kim JE
• Park KD

• KMID: 2160050
• DOI: http://doi.org/10.4046/trd.2001.51.6.603

Abstract

Intracranial vasculitis is a rare and disastrous complication of tuberculous meningitis if not treated properly. Focal neurologic deficits according to the vessels involved are common manifestation. Here, we report a 29-year-old man who suffered abrupt, bizarre behavioral changes caused by vasculitis complicating tuberculous meningoencephalitis. The diagnosis of tuberculous meningitis is based upon both the CSF findings and a chest X-ray. His systemic symptoms disappeared by after being administered antituberculous medication but various psychotic features such as hypersomnia, hyperphagia and aggressivebehavior continued. A brain MRI showed multiple small parenchymal tuberculous nodules, and the brain MR angiography revealed a narrowing of the proimal middle cerebral arteries and a reduced visualization of the cerebral vessels, suggesting widespread vasculitis. Intravenous dexamethasone successfully ameliorated his behavioral changes. In addition both the follow up brain MRI and angiography showed a normalization of the previous findings.

Keyword

Tuberculosis; Vasculitis; Meningoencephalitis

MeSH Terms

Adult
Angiography
Brain
Dexamethasone
Diagnosis
Disorders of Excessive Somnolence
Follow-Up Studies
Humans
Hyperphagia
Magnetic Resonance Imaging
Meningoencephalitis*
Middle Cerebral Artery
Neurologic Manifestations
Thorax
Tuberculosis
Tuberculosis, Meningeal
Vasculitis
Dexamethasone