Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical sciences, Raebareily Road, 226014 Lucknow, UP, India.
Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical sciences, Raebareily Road, 226014 Lucknow, UP, India.
J Neuroradiol. 2018 Mar;45(2):130-135. doi: 10.1016/j.neurad.2017.09.005. Epub 2017 Sep 29.
Central nervous system infection especially pyogenic results in cerebral venous sinus thrombosis. Tuberculous meningitis (TBM) although associated with infarctions but there is no comprehensive study evaluating the role of CVST contributing in infarction.
To evaluate cerebral arterial and venous system using MR angiography (MRA) and MR venography (MRV) in TBM, and correlate with clinical and MRI findings.
Consecutive patients with TBM were evaluated clinically and their consciousness was assessed by using Glasgow Coma scale. Cerebrospinal fluid analysis was done. Patients were subjected to MRI, MRA and MRV studies. The severity of TBM was categorized as grades I to III. Presence of infarction on MRI and its cause as arterial or venous was noted based on MRA and MRV abnormalities.
Twenty-six patients were included whose median age was 23 years. Seven (26.9%) patients had stage I, 12 (46.2%) stage II and 7 (26.9%) stage III TBM. MRI revealed infarction in 13 (50%) patients and were in tubercular zone (caudate, lentiform nuclei, anterior limb and genu of internal capsule, and anterior thalamus) in all except one. MRA was abnormal in 11/25 (42.3%) patients; 7 had middle cerebral artery, 2 both posterior cerebral artery and middle cerebral artery, and 2 had narrowing of all intracranial vessels. MRV however did not reveal any evidence of CVST although revealed variation in normal anatomy in 14 (53.8%) patients, commonest being hypoplastic transverse sinus.
In TBM, infarction occurs in 50% patients, and is of arterial in origin. Cerebral venous system is usually spared in TBM.
中枢神经系统感染，特别是化脓性感染，可导致脑静脉窦血栓形成。结核性脑膜炎（TBM）虽然与梗死有关，但尚无全面评估脑静脉窦血栓形成在梗死中作用的研究。
使用磁共振血管造影（MRA）和磁共振静脉造影（MRV）评估 TBM 患者的脑动脉和静脉系统，并与临床和 MRI 发现相关联。
连续评估 TBM 患者，使用格拉斯哥昏迷量表评估其意识。进行脑脊液分析。对患者进行 MRI、MRA 和 MRV 研究。根据 TBM 的严重程度分为 I 级至 III 级。根据 MRA 和 MRV 异常，注意 MRI 上的梗死及其是动脉或静脉的原因。
共纳入 26 例患者，中位年龄为 23 岁。7 例（26.9%）患者为 I 期，12 例（46.2%）为 II 期，7 例（26.9%）为 III 期 TBM。MRI 显示 13 例（50%）患者有梗死，且均位于结核区域（尾状核、豆状核、内囊前肢和膝部、前丘脑），除 1 例外均为动脉性梗死。25 例患者中有 11 例 MRA 异常（42.3%）；7 例为大脑中动脉，2 例为大脑后动脉和大脑中动脉，2 例为颅内所有血管狭窄。然而，MRV 并未显示任何 CVST 证据，尽管在 14 例（53.8%）患者中显示正常解剖结构变异，最常见的是横窦发育不全。
在 TBM 中，50%的患者发生梗死，且起源于动脉。脑静脉系统在 TBM 中通常不受累。
