Intracranial Artery Injury in HIV-negative Tuberculous Meningitis

A High-Resolution Vessel Wall Imaging Study
  • Tingting Lu
  • Yan Zou
  • Ting Jiang
  • Yu Yang
  • Aimin Wu
  • Hongbing Chen
  • Zhuang Kang
  • Xinqing Lin
  • Yimin FangEmail author
  • Zhengqi LuEmail author
Original Article



The features of intracranial arterial injury in tuberculous meningitis (TBM) are of important diagnostic and prognostic value. The study aimed to elucidate the high-resolution vessel wall imaging (HR-VWI) manifestations of intracranial arterial insults in TBM.


The clinical data, routine cranial magnetic resonance imaging, magnetic resonance angiography (MRA) and HR-VWI before and after contrast enhancement of intracranial arteries in clinically diagnosed TBM patients were retrospectively analyzed.


In this study 27 TBM patients were included. Abnormalities in the intracranial arteries were detected in all patients using HR-VWI. Typical vessel insults included nodular or granular lesions, related thickness and prominent enhancement in the wall, and lumen narrowing or occlusion. The most frequently involved arteries were the C4 segment of the internal carotid artery and the P1 segment of the posterior cerebral artery. The lesions were consistent with disease stage and disease duration and correlated with infarction.


The use of HR-VWI revealed that cerebral artery involvement in patients with TBM is much more common and extensive than in previous radiological reports. The use of HR-VWI improves recognition of arterial pathologies and has diagnostic value in patients with TBM.


Magnetic resonance angiography Internal carotid artery Middle cerebral artery High-resolution vessel wall imaging Tuberculous meningitis 



This study was supported by the Medical Scientific Research Foundation of Guangdong Province, China (A2016224), the National Natural Science Foundation of China (81701172) and the Special Fund Project of Science and Technology in Guangdong Province (2017B020247038).

Conflict of interest

T. Lu, Y. Zou, T. Jiang, Y. Yang, A. Wu, H. Chen, Z. Kang, X. Lin, Y. Fang and Z. Lu declare that they have no competing interests.


  1. 1.
  2. 2.
    Thwaites GE, van Toorn R, Schoeman J. Tuberculous meningitis: More questions, still too few answers. Lancet Neurol. 2013;12:999–1010.CrossRefGoogle Scholar
  3. 3.
    Brancusi F, Farrar J, Heemskerk D. Tuberculous meningitis in adults: A review of a decade of developments focusing on prognostic factors for outcome. Future Microbiol. 2012;7:1101–16.CrossRefGoogle Scholar
  4. 4.
    Erdem H, Ozturk-Engin D, Tireli H, Kilicoglu G, Defres S, Gulsun S, Sengoz G, Crisan A, Johansen IS, Inan A, Nechifor M, Al-Mahdawi A, Civljak R, Ozguler M, Savic B, Ceran N, Cacopardo B, Inal AS, Namiduru M, Dayan S, Kayabas U, Parlak E, Khalifa A, Kursun E, Sipahi OR, Yemisen M, Akbulut A, Bitirgen M, Popovic N, Kandemir B, Luca C, Parlak M, Stahl JP, Pehlivanoglu F, Simeon S, Ulu-Kilic A, Yasar K, Yilmaz G, Yilmaz E, Beovic B, Catroux M, Lakatos B, Sunbul M, Oncul O, Alabay S, Sahin-Horasan E, Kose S, Shehata G, Andre K, Dragovac G, Gul HC, Karakas A, Chadapaud S, Hansmann Y, Harxhi A, Kirova V, Masse-Chabredier I, Oncu S, Sener A, Tekin R, Elaldi N, Deveci O, Ozkaya HD, Karabay O, Senbayrak S, Agalar C, Vahaboglu H. Hamsi scoring in the prediction of unfavorable outcomes from tuberculous meningitis: Results of Haydarpasa-II study. J Neurol. 2015;262:890–8.CrossRefGoogle Scholar
  5. 5.
    Misra UK, Kalita J, Maurya PK. Stroke in tuberculous meningitis. J Neurol Sci. 2011;303:22–30.CrossRefGoogle Scholar
  6. 6.
    Lu TT, Lin XQ, Zhang L, Cai W, Dai YQ, Lu ZZ, Wu AM, Bao J, Yang Y, Hu XQ, Lu ZQ. Magnetic resonance angiography manifestations and prognostic significance in HIV-negative tuberculosis meningitis. Int J Tuberc Lung Dis. 2015;19:1448–54.CrossRefGoogle Scholar
  7. 7.
    Singh B, Garg RK, Singh MK, Verma R, Malhotra HS, Jain A, Singh R, Kohli N, Phadke RV, Shukla R, Parihar A. Computed tomography angiography in patients with tuberculous meningitis. J Infect. 2012;64:565–72.CrossRefGoogle Scholar
  8. 8.
    Chatterjee D, Radotra BD, Vasishta RK, Sharma K. Vascular complications of tuberculous meningitis: An autopsy study. Neurol India. 2015;63:926–32.CrossRefGoogle Scholar
  9. 9.
    Mandell DM, Mossa-Basha M, Qiao Y, Hess CP, Hui F, Matouk C, Johnson MH, Daemen MJ, Vossough A, Edjlali M, Saloner D, Ansari SA, Wasserman BA, Mikulis DJ, Vessel Wall Imaging Study Group of the American Society of Neuroradiology. Intracranial Vessel Wall MRI: Principles and expert consensus recommendations of the American Society of Neuroradiology. AJNR Am J Neuroradiol. 2017;38:218–29.CrossRefGoogle Scholar
  10. 10.
    Choi YJ, Jung SC, Lee DH. Vessel wall imaging of the Intracranial and cervical carotid arteries. J Stroke. 2015;17:238–55.CrossRefGoogle Scholar
  11. 11.
    Lehman VT, Brinjikji W, Kallmes DF, Huston J Rd, Lanzino G, Rabinstein AA, Makol A, Mossa-Bosha M. Clinical interpretation of high-resolution vessel wall MRI of intracranial arterial diseases. Br J Radiol. 2016;89:20160496.CrossRefGoogle Scholar
  12. 12.
    Marais S, Thwaites G, Schoeman JF, Torok ME, Misra UK, Prasad K, Donald PR, Wilkinson RJ, Marais BJ. Tuberculous meningitis: A uniform case definition for use in clinical research. Lancet Infect Dis. 2010;10:803–12.CrossRefGoogle Scholar
  13. 13.
    Boulouis G, de Boysson H, Zuber M, Guillevin L, Meary E, Costalat V, Pagnoux C, Naggara O, French Vasculitis G. Primary Angiitis of the central nervous system: Magnetic resonance imaging spectrum of Parenchymal, meningeal, and vascular lesions at baseline. Stroke. 2017;48:1248–55.CrossRefGoogle Scholar
  14. 14.
    Obusez EC, Hui F, Hajj-Ali RA, Cerejo R, Calabrese LH, Hammad T, Jones SE. High-resolution MRI vessel wall imaging: Spatial and temporal patterns of reversible cerebral vasoconstriction syndrome and central nervous system vasculitis. AJNR Am J Neuroradiol. 2014;35:1527–32.CrossRefGoogle Scholar
  15. 15.
    Schumacher HC, Meyers PM, Higashida RT, Derdeyn CP, Lavine SD, Nesbit GM, Sacks D, Rasmussen P, Wechsler LR. Reporting standards for angioplasty and stent-assisted angioplasty for intracranial atherosclerosis. Stroke. 2009;40:e348–65.CrossRefGoogle Scholar
  16. 16.
    Yang WJ, Wong KS, Chen XY. Intracranial atherosclerosis: From microscopy to high-resolution magnetic resonance imaging. J Stroke. 2017;19:249–60.CrossRefGoogle Scholar
  17. 17.
    Misra UK, Kalita J, Maurya PK. Stroke in tuberculous meningitis. J Neurol Sci. 2011;303:22–30.CrossRefGoogle Scholar
  18. 18.
    Klein IF, Lavallee PC, Touboul PJ, Schouman-Claeys E, Amarenco P. In vivo middle cerebral artery plaque imaging by high-resolution MRI. Neurology. 2006;67:327–9.CrossRefGoogle Scholar
  19. 19.
    Singh B, Garg RK, Singh MK, Verma R, Malhotra HS, Jain A, Singh R, Kohli N, Phadke RV, Shukla R, Parihar A. Computed tomography angiography in patients with tuberculous meningitis. J Infect. 2012;64:565–72.CrossRefGoogle Scholar
  20. 20.
    Kalita J, Prasad S, Maurya PK, Kumar S, Misra UK. MR angiography in tuberculous meningitis. Acta Radiol. 2012;53:324–9.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Tingting Lu
    • 1
  • Yan Zou
    • 2
  • Ting Jiang
    • 2
  • Yu Yang
    • 1
  • Aimin Wu
    • 1
  • Hongbing Chen
    • 3
  • Zhuang Kang
    • 2
  • Xinqing Lin
    • 4
  • Yimin Fang
    • 5
    Email author
  • Zhengqi Lu
    • 1
    Email author
  1. 1.Department of Neurology, The Third Affiliated HospitalSun Yat-sen UniversityGuangzhouChina
  2. 2.Department of Radiology, The Third Affiliated HospitalSun Yat-sen UniversityGuangzhouChina
  3. 3.Department of Neurology and Stroke Center, The First Affiliated HospitalSun Yat-sen UniversityGuangzhouChina
  4. 4.State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated HospitalGuangzhou Medical UniversityGuangzhouChina
  5. 5.Guangzhou Chest HospitalGuangzhouChina

Personalised recommendations