To report a case of tuberculous meningitis in a toddler presenting with multifocal cerebral infarcts and hydrocephalus.
Approach:
Case Description: A 2-year-old boy presented with febrile illness and focal neurological deficits. Imaging revealed multiple acute infarcts and cerebrospinal fluid analysis confirmed tuberculous meningitis.
Diagnostic Assessment: Initial imaging showed no acute intracranial abnormality. Subsequent MRI revealed punctate infarcts and CSF analysis indicated lymphocytic pleocytosis and hypoglycorrhachia.
Treatment: The patient was treated with a four-drug antituberculosis regimen and corticosteroids, and underwent ventriculoperitoneal shunt placement for hydrocephalus.
Key Findings:
The patient exhibited clinical–radiological dissociation, with neurological deficits occurring before classic imaging findings.
Initial imaging showed unilateral infarcts despite normal large-vessel CT angiogram.
Follow-up imaging demonstrated rapid progression to bilateral infarcts and obstructive hydrocephalus.
Interpretation:
The case emphasizes the importance of early diagnosis and treatment of tuberculous meningitis to prevent severe neurological outcomes.
Limitations:
The case is based on a single patient, limiting generalizability.
Long-term outcomes and follow-up data are not provided.
Conclusion:
Early empirical therapy based on CSF profiles and epidemiological risk is crucial in managing tuberculous meningitis in children.
