A Case Report of Stroke-like Syndrome: Tuberculous Encephalopathy

Abstract

Background: Stroke-like syndrome is a stroke mimic, usually common in the young and accurate diagnosis has considerable impact in terms of treatment choices and outcomes. Objectives: To emphasise the need for high index of suspicion and the need for multidisciplinary approach and accurate diagnosis of stroke-like syndrome. Case Report: 32 years old woman who presented with recurrent headache of a year duration with right upper limb weakness of 3 months that later involved lower limb 1month and inability to talk 2 days to presentation. Examination revealed a young woman, conscious but aphasic, emaciated, afebrile, anicteric and nil pedal oedema. Neurological findings includes expressive aphasia, right facioparesis and right hemiparesis. Other systemic examinations were essentially normal. A diagnosis of left hemispheric ischaemic stroke was initially entertained. Brain computerized tomography revealed infarct involving the left frontal and temporal lobes but Echocardiography revealed Tuberculous pericarditis, a suspicion of stroke mimic of infective origin was entertained. Diagnosis was confirmed by ‘trial of treatment’ of anti-tuberculosis, which resulted in dramatic resolution of symptoms within 4 weeks of anti-tuberculosis drugs. Conclusion: There is need for high index of suspicion, accurate diagnosis and multidisciplinary approach for appropriate treatment choices and outcomes.