Deng Xuhui, Huang Qiuhui, Huang Hua, Chen Shengri, Wang Xue, Liang Zhijian
Department of Neurology, First Affiliated Hospital of Guangxi Medical University, China.
Department of Neurology, Affiliated Yuebei People's Hospital of Shantou University Medical College, China.
J Clin Tuberc Other Mycobact Dis. 2024 Dec 16;38:100508. doi: 10.1016/j.jctube.2024.100508. eCollection 2025 Feb.
Patients with tuberculous meningitis (TBM) are at high risk of ischemic stroke, and stroke is a poor prognosticator of TBM. However, reports regarding the predictors of stroke in TBM patients are scanty. The aim of this study was to investigate the clinical characteristics and predictors of tuberculous meningitis-related ischemic stroke (TBMRIS).
This retrospective study was conducted among TBM patients without traditional vascular risk factors from a tertiary care hospital between January 2017 and November 2022. Patients were divided into TBMRIS group and TBM-only group according to presence of stroke. Clinical, laboratory and radiological variables were compared between the two groups. Predictors of stroke were identified using binary logistic regression analysis.
A total of 176 TBM patients were included in the study. Forty-nine patients with stroke were classified as TBMRIS group and 127 patients without stroke were classified as TBM-only group. In TBMRIS group, 41 (83.7 %) patients experienced stroke within 3 months after the onset of meningitis symptoms and 10 (20.4 %) patients presented silent stroke. Stroke occurred in basal ganglia in 57.1 % of patients. About 73.5 % of patients showed multiple stroke lesions and 38.8 % of patients had stroke involving multiple vascular territories. There were significant differences in focal neurological deficit, stage of meningitis, short-term outcome, serum sodium, cerebrospinal fluid (CSF) white cell count, CSF adenosine deaminase (ADA), CSF protein, leptomeningeal enhancement, tuberculoma between TBMRIS group and TBM-only group. Binary logistic regression analysis revealed that focal neurological deficit, CSF white cell count and leptomeningeal enhancement were the independent risk factors for stroke, and tuberculoma was negatively correlated with stroke.
Most of TBMRIS develop within 3 months after the onset of meningitis symptoms and basal ganglia is the most frequent site. Multiple stroke lesions and involvement of multiple vascular territories are commonly observed. Focal neurological deficit, CSF white cell count and leptomeningeal enhancement are the predictors of stroke in patients with TBM.
结核性脑膜炎（TBM）患者发生缺血性卒中的风险很高，且卒中是TBM预后不良的指标。然而，关于TBM患者卒中预测因素的报道较少。本研究的目的是调查结核性脑膜炎相关缺血性卒中（TBMRIS）的临床特征和预测因素。
本回顾性研究于2017年1月至2022年11月在一家三级医院对无传统血管危险因素的TBM患者进行。根据是否发生卒中，将患者分为TBMRIS组和单纯TBM组。比较两组患者的临床、实验室和影像学变量。采用二元逻辑回归分析确定卒中的预测因素。
本研究共纳入176例TBM患者。49例发生卒中的患者被分类为TBMRIS组，127例未发生卒中的患者被分类为单纯TBM组。在TBMRIS组中，41例（83.7%）患者在脑膜炎症状发作后3个月内发生卒中，10例（20.4%）患者出现无症状性卒中。57.1%的患者卒中发生在基底节区。约73.5%的患者表现为多发性卒中病灶，38.8%的患者卒中累及多个血管区域。TBMRIS组和单纯TBM组在局灶性神经功能缺损、脑膜炎分期、短期预后、血清钠、脑脊液（CSF）白细胞计数、CSF腺苷脱氨酶（ADA）、CSF蛋白、软脑膜强化、结核瘤方面存在显著差异。二元逻辑回归分析显示，局灶性神经功能缺损、CSF白细胞计数和软脑膜强化是卒中的独立危险因素，结核瘤与卒中呈负相关。
大多数TBMRIS在脑膜炎症状发作后3个月内发生，基底节区是最常见的部位。常见多发性卒中病灶和多个血管区域受累。局灶性神经功能缺损、CSF白细胞计数和软脑膜强化是TBM患者卒中的预测因素。
