Paradoxical progression of intracranial tuberculomas and anterior cerebral artery infarction

Abstract

An immunocompetent 52-year-old woman presented with subacute onset of headache, vomiting, and mental deterioration after 3 weeks’ history of fever, cough, and dyspnea. Diagnostic workups confirmed pulmonary miliary tuberculosis, multiple intracranial tuberculomas, and tuberculous meningovasculitis causing cerebral infarction (figure, A–D). Treatments with antituberculous medications (oral isoniazid 300 mg/day, rifampin 450 mg/day, pyrazinamide 1,000 mg/day, IM streptomycin 750 mg/day) and IV dexamethasone (16 mg/day) were commenced. …