Clinical Report: A Toddler with Tuberculous Meningitis Exhibiting Multifocal Cerebral Infarcts and Hydrocephalus

Overview

This case study presents a 2-year-old boy with tuberculous meningitis who exhibited multifocal cerebral infarcts and hydrocephalus.

Background

Tuberculous meningitis (TBM) is a critical pediatric emergency with high mortality and long-term neurodisability risks. The condition often leads to complications such as hydrocephalus and inflammatory vasculopathy.

Data Highlights

No numerical data or trial data presented in the article.

Key Findings

• The patient presented with acute focal neurological deficits and multiple unilateral punctate infarcts.
• Cerebrospinal fluid analysis showed lymphocytic pleocytosis and hypoglycorrhachia.
• Diagnosis was confirmed through positive interferon-gamma release assay and mycobacterial nucleic acid amplification testing.
• Follow-up imaging revealed rapid progression to bilateral infarcts and obstructive hydrocephalus.
• The patient was treated with a four-drug antituberculosis regimen and corticosteroids, leading to clinical improvement.

Clinical Implications

Clinicians should maintain a high index of suspicion for TBM in pediatric patients presenting with neurological symptoms. Early empirical therapy based on cerebrospinal fluid profiles and epidemiological risk factors is crucial.

Conclusion

This case highlights the phenomenon of clinical–radiological dissociation in early pediatric tuberculous meningitis.

Related Resources & Content

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