From the Department of Neurology.
Department of Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, India.
QJM. 2018 Jul 1;111(7):455-460. doi: 10.1093/qjmed/hcy072.
Both stroke and cerebral salt wasting (CSW) are common in tuberculous meningitis (TBM), but there is paucity of studies evaluating their combined effect.
The present study has been undertaken to evaluate the spectrum of stroke in TBM and its relation to CSW.
Hospital-based prospective cohort study.
Eighty-one patients with TBM diagnosed on the basis of clinical, cerebrospinal fluid and magnetic resonance imaging (MRI) criteria were prospectively included. Stroke was diagnosed on the basis of clinical, MRI findings or both. Stroke risk factors were noted. Patients with hyponatremia were categorized into CSW and other causes. Three and 6 months outcome was defined using modified Rankin Scale (mRS) as good (<2) or poor (≥2).
Out of 81 patients with TBM, 32 (39.5%) had ischemic stroke. CSW was the commonest cause of hyponatremia and occurred in 34 (42%) patients. Stroke occurred in tubercular zone in 10, ischemic zone in 15 and both in 7 patients. The patients with ischemic zone infarction were older and had stroke risk factors such as diabetes mellitus, hypertension and hyperlipidemia. Out of 16 (47%) patients with CSW, 10 (62.5%) had stroke during the polyuric phase. The patients with CSW had more frequent deep white matter infarcts (P = 0.01) which were in internal border zone in 4 (40%).
In TBM, stroke occurred in 39.5% of the patients, 50% of whom had CSW. Volume contraction due to CSW may contribute to stroke.
中风和脑耗盐综合征（CSW）在结核性脑膜炎（TBM）中都很常见，但评估它们联合作用的研究很少。
本研究旨在评估 TBM 中风的谱及其与 CSW 的关系。
基于医院的前瞻性队列研究。
前瞻性纳入 81 例基于临床、脑脊液和磁共振成像（MRI）标准诊断的 TBM 患者。根据临床、MRI 结果或两者结合诊断中风。记录中风的危险因素。将低钠血症患者分为 CSW 和其他原因。使用改良 Rankin 量表（mRS）定义 3 个月和 6 个月的预后为良好（<2）或不良（≥2）。
在 81 例 TBM 患者中，32 例（39.5%）发生缺血性中风。CSW 是低钠血症最常见的原因，发生在 34 例（42%）患者中。10 例患者中风发生在结核区，15 例患者发生在缺血区，7 例患者同时发生在这两个区。发生缺血区梗死的患者年龄较大，且有糖尿病、高血压和高脂血症等中风危险因素。在 16 例（47%）CSW 患者中，有 10 例（62.5%）在多尿期发生中风。CSW 患者更常发生深部白质梗死（P=0.01），其中 4 例（40%）位于内边界区。
在 TBM 中，39.5%的患者发生中风，其中 50%的患者合并 CSW。CSW 引起的血容量减少可能导致中风。
