Skip to main content

Advertisement

SpringerLink
Log in

Brainstem ischemic lesions on MRI in children with tuberculous meningitis: with diffusion weighted confirmation

  • Original Paper
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Introduction

The Western Cape in South Africa has one of the highest incidences of tuberculous meningitis (TBM) in the world. Despite therapy, the outcome in children with advanced TBM remains dismal. Magnetic resonance imaging (MRI) has been shown to be superior to computed tomography (CT) in demonstrating ischemia in TBM, especially of the brainstem. The objective of this study was to characterize brainstem lesions and association with clinical findings in children with TBM by using MRI.

Materials and methods

CT and multiplanar MRI scans were performed in 30 children with proven TBM. From this group, a subgroup with radiological ischemic changes of the brainstem were identified. Radiological findings in these patients were then correlated with severity of disease, motor deficit, and outcome after 6 months.

Results

Radiological brainstem abnormalities were identified in 14 out of 30 children. Thirty-eight brainstem lesions were confirmed to be ischemic. The severity of disease at presentation, degree of motor deficit, and developmental outcome after 6 months of the children with ischemic brainstem lesions was poorer compared to those children without brainstem involvement. However, both sensitivity and specificity of the MRI brainstem lesion detection for clinical outcome proved low.

Conclusion

A significant percentage of children with TBM have ischemic brainstem lesions. These are poorly visualized on conventional CT. MRI scanning is more sensitive in detecting these lesions and localizing them. There appears to be some association between MRI-detected brainstem lesions and clinical outcome. The exact meaning of these lesions and their implication for the patient's management require further clarification.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Griffiths SJ, Sgouros S, James G, John P (2000) Intraventricular hemorrhage due to ruptured posterior inferior cerebellar artery aneurysm in tuberculous meningitis. Child's Nerv Syst 16:872–874

    Article  CAS  Google Scholar 

  2. Van der Weert EM, Hartgers NM, Schaaf HS, Eley BS, Pitcher RD, Wieselthaler NA, Laubscher R, Donald PR, Schoeman JF (2006) Comparison of diagnostic criteria of Tuberculous Meningitis in Human Immunodeficiency Virus-infected and Uninfected Children. Pediatr Infect Dis 25:65–69

    Article  Google Scholar 

  3. Topley JM, Bamber S, Coovadia HM, Corr PD (1998) Tuberculous meningitis and co-infection with HIV. Ann Trop Paediatr 18:261–266

    PubMed  CAS  Google Scholar 

  4. Schoeman J, Hewlett R, Donald P (1988) MRI of childhood tuberculous meningitis. Neuroradiology 30:473–477

    Article  PubMed  CAS  Google Scholar 

  5. Andronikou S, Wilmshurst J, Hatherhill M, Van Toorn R (2006) Distribution of brain infarction in children with TBM and correlation with outcome score at 6 months. Pediatr Radiol 36:1289–1294

    Article  PubMed  Google Scholar 

  6. Kalita J, Misra UK (2001) Brainstem auditory evoked potentials in tubercular meningitis and their correlation with radiological findings. Neurol India 49:51–54

    PubMed  CAS  Google Scholar 

  7. Chan KH, Cheung RTF, Lee R, Mak W, Ho SL (2005) Cerebral infarcts Complicating Tuberculous Meningitis. Cerebrovasc Dis 19:391–395

    Article  PubMed  CAS  Google Scholar 

  8. Schoeman JF, Rutherfoord GS, Hewlett RH (1997) Acute stroke in a child with miliary tuberculosis. Clin Neuropathol 16:303–308

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology at Tygerberg Academic Hospital, University of Stellenbosch, Stellenbosch, South Africa

    Dirk Johannes van der Merwe & Manana Pienaar

  2. Department of Radiology, University of Cape Town, Cape Town, South Africa

    Savvas Andronikou

  3. Department of Pediatrics and Child Health at Tygerberg Children’s Hospital, University of Stellenbosch, Stellenbosch, South Africa

    Ronald Van Toorn

  4. Department of Radiology, Tygerberg Hospital, 4th floor, Private Bag X3, Parow, 7505, South Africa

    Dirk Johannes van der Merwe

Authors
  1. Dirk Johannes van der Merwe
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Savvas Andronikou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ronald Van Toorn
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Manana Pienaar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dirk Johannes van der Merwe.

Rights and permissions

Reprints and permissions

About this article

Cite this article

van der Merwe, D.J., Andronikou, S., Van Toorn, R. et al. Brainstem ischemic lesions on MRI in children with tuberculous meningitis: with diffusion weighted confirmation. Childs Nerv Syst 25, 949–954 (2009). https://doi.org/10.1007/s00381-009-0899-2

Download citation

  • Received:

  • Revised:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-009-0899-2

Keywords

Search

Navigation