Cerebral venous sinus thrombosis associated with tuberculous meningitis: a case report and review of the literature

Abstract

Background: Central nervous system tuberculosis (TB) has a dismal prognosis with higher rates of mortality and neurological deficits. Few reported cases showed that the TB meningitis was associated with cerebral sinus venous thrombosis (CSVT). In this case report, the clinical course, diagnostic challenges, and management of CSVT associated with TB meningitis is presented. Case Presentation: A 28-year-old female presented with headache, vomiting, altered sensorium, and Glasgow Comma Scale of 11. Non-enhanced computed tomography (CT) of the head and CT venography with contrast showed a filling defect within the proximal part of the left internal jugular vein just prior to left sigmoid sinus indicating thrombosis. Brain magnetic resonance imaging (MRI) confirmed the thrombosis of the left jugular vein. Cerebrospinal fluid (CSF) analysis showed only a moderate elevation of white blood cells (WBCs) with negative culture for organisms. No improvement after starting empirical antibiotics and acyclovir was observed. Due to the exclusion of other infections, the absence of other established risk factors of CSVT, CSF, and imaging findings that was consistent with tuberculous meningitis (TBM), and a positive history of TB sick contact; anti-TB therapy was initiated, which showed significant improvement that confirmed the diagnosis of TBM. Conclusion: A case of CSVT secondary to TBM was presented. Since clinical examination alone might not be sufficient to solve such a diagnostic dilemma, a multidisciplinary approach including radiologists, neurologists, and infectious specialists is warranted to promote proper awareness, detection, and management of CVST associated TB.