Kappel Ari D, Lehman Laura L, Northam Weston T, See Alfred P, Smith Edward R
Department of Neurosurgery (ADK, WTN, APS, ERS), Boston Children's Hospital, Harvard Medical School, Boston; Department of Neurosurgery (ADK), Brigham and Women's Hospital, Harvard Medical School, Boston; and Department of Neurology (LLL), Boston Children's Hospital, Harvard Medical School, MA.
Neurol Clin Pract. 2023 Feb;13(1):e200121. doi: 10.1212/CPJ.0000000000200121. Epub 2023 Jan 18.
Tuberculosis is uncommon in the United States and a rare cause of meningitis in children with severe neurologic consequences. Tuberculous meningitis (TBM) is an even rarer cause of moyamoya syndrome with only a handful of cases previously reported.
We report the case of a female patient who initially presented at 6 years of age with TBM and developed moyamoya syndrome requiring revascularization surgery.
She was found to have basilar meningeal enhancement and right basal ganglia infarcts. She was treated with 12 months of antituberculosis therapy and 12 months of enoxaparin and maintained on daily aspirin indefinitely. However, she developed recurrent headaches and transient ischemic attacks and was found to have progressive bilateral moyamoya arteriopathy. At age 11 years, she underwent bilateral pial synangiosis for the treatment of her moyamoya syndrome.
Moyamoya syndrome is a rare but serious sequalae of TBM and may be more common in pediatric patients. The risk of stroke may be mitigated by pial synangiosis or other revascularization surgeries in carefully selected patients.
结核病在美国并不常见，是儿童脑膜炎的罕见病因，会造成严重的神经系统后果。结核性脑膜炎（TBM）是烟雾病综合征更为罕见的病因，此前仅有少数病例报道。
我们报告了一名女性患者的病例，该患者6岁时初发TBM，随后发展为烟雾病综合征，需要进行血管重建手术。
她被发现存在基底脑膜强化和右侧基底节梗死。她接受了12个月的抗结核治疗和12个月的依诺肝素治疗，并无限期每日服用阿司匹林。然而，她出现了复发性头痛和短暂性脑缺血发作，并被发现患有进行性双侧烟雾病性动脉病变。11岁时，她接受了双侧软脑膜血管吻合术以治疗烟雾病综合征。
烟雾病综合征是TBM一种罕见但严重的后遗症，在儿科患者中可能更为常见。在精心挑选的患者中，软脑膜血管吻合术或其他血管重建手术可能会降低中风风险。
