Case Report: Tuberculous meningitis presenting with multifocal cerebral infarction and hydrocephalus in a toddler

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Tuberculous meningitis is a severe pediatric emergency with high rates of neurological disability due to hydrocephalus and inflammatory vasculopathy.
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A 2-year-old boy presented with febrile illness and developed focal neurological deficits, with MRI revealing multiple unilateral acute infarcts.
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Cerebrospinal fluid analysis showed lymphocytic pleocytosis and hypoglycorrhachia, supporting the diagnosis of tuberculous meningitis.
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Follow-up imaging demonstrated rapid progression to bilateral infarcts, basilar leptomeningeal enhancement, and obstructive hydrocephalus.
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The patient was treated with a four-drug antituberculosis regimen and corticosteroids, leading to clinical improvement after shunt placement.

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