Department of Neurology, All India Institute of Medical Sciences, Rishikesh, 249203, India.
Department of Neurology, All India Institute of Medical Sciences, Raipur, 492099, India.
Trans R Soc Trop Med Hyg. 2021 Oct 1;115(10):1160-1167. doi: 10.1093/trstmh/trab070.
To compare the frequency and patterns of stroke, the specificity of tubercular zone (TBZ) infarction and its effect on outcomes in TB (TBM) and cryptococcal meningitis (CM).
This retrospective study was conducted at two tertiary centres in India from May 2018 to July 2020. Sixty-one patients with TBM and 22 with CM were included. The primary outcome was the proportions of TBM and CM patients with infarction. Secondary outcomes included the anatomical locations of infarction and in-hospital mortality.
Infarction was noted in 52.5% of patients with TBM and in 54.5% of those with CM (p=0.87), with caudate head infarcts in 9.4% vs 41.7% (p=0.01), cerebellar in 9.4% vs 33.3% (p=0.05), thalamic in 25% vs 0% and lobar in 28.1% vs 0%, respectively. In TBM, the infarcts were located in the TBZ in 3 (9.4%), in the ischaemic zone in 23 (71.9%), while 6 (18.8%) patients showed infarcts in both, while in CM, the infarcts were in 0 (0%), 6 (50%) and 6 (50%) patients, respectively. Infarcts were not associated with in-hospital mortality, either in TBM or CM.
Caudate head and cerebellar infarction was more common in CM, while thalamic and lobar infarcts were more frequent in TBM. TBZ infarcts were not specific to TBM.
为了比较中风的频率和模式、结核区（TBZ）梗死的特异性及其对结核性脑膜炎（TBM）和隐球菌性脑膜炎（CM）结局的影响。
本回顾性研究于 2018 年 5 月至 2020 年 7 月在印度的两家三级中心进行。纳入了 61 例 TBM 患者和 22 例 CM 患者。主要结局是 TBM 和 CM 患者中梗死的比例。次要结局包括梗死的解剖位置和院内死亡率。
TBM 患者中梗死的发生率为 52.5%，CM 患者为 54.5%（p=0.87），尾状核梗死发生率分别为 9.4%和 41.7%（p=0.01），小脑梗死发生率分别为 9.4%和 33.3%（p=0.05），丘脑梗死发生率分别为 25%和 0%，大脑皮质梗死发生率分别为 28.1%和 0%。在 TBM 中，3 例（9.4%）的梗死位于 TBZ，23 例（71.9%）位于缺血区，而 6 例（18.8%）的患者在这两个区域均有梗死；在 CM 中，梗死分别位于 0（0%）、6（50%）和 6（50%）例患者中。在 TBM 或 CM 中，梗死均与院内死亡率无关。
CM 中更常见的是尾状核头和小脑梗死，而 TBM 中更常见的是丘脑和大脑皮质梗死。TBZ 梗死并非 TBM 所特有。
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