Acta Scientific Neurology (ASNE) (ISSN: 2582-1121)

Research Article Volume 5 Issue 6

Non-Enhanced 3D-TOF-MRA Evaluation in Tuberculous Meningitis and Correlation of Angiographic Abnormalities with Clinical Outcome

Chatterjee P*, Saharia B and Handique SK

Department of Neuroradiology, GNRC Hospital, Dispur, Guwahati, Assam, India

*Corresponding Author: Chatterjee P, Department of Neuroradiology, GNRC Hospital, Dispur, Guwahati, Assam, India.

Received: March 18, 2022; Published: May 27, 2022

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Abstract

Background and Purpose: Neurovascular complications are the main causes of morbidity and mortality in tuberculous meningitis (TBM). However, there is paucity of data available on the spectrum of MRA abnormalities in TBM. We undertook this study to assess the spectrum of abnormalities involving the intracranial arteries in TBM by non-enhanced three- dimensional time-of-flight (3D-TOF) MRA and to determine if there is any relationship between abnormal angiogram and the disease outcome.

Materials and Methods: Twenty-five patients of TBM had clinical, laboratory, MRI and non-enhanced TOF MRA evaluation. Additionally, 11 patients underwent CT scans during follow up. The spectrum of abnormalities in MRA was evaluated. All patients were evaluated for the clinical outcome using the Glasgow outcome score (GOS) at discharge, 3 months and 6 months.

Results: Infarcts were noted in 16 patients, seen predominantly in the distribution of lateral lenticulostriate artery territory (68.75%). 64% patients had abnormal angiograms. MCA was most commonly involved (93.75%) followed by PCA (25%), supraclinoid ICA (18.75%) and ACA (6.25%). Arteries and their segments around the circle of Willis were most commonly involved. The MRA abnormalities include focal stenosis (60%), irregular segmental stenosis (12%), collateral formation (8%) and complete occlusion (4%). Poor outcome (GOS of 1, 2 and 3) was significantly found in patients with abnormal angiograms (p = 0.014).

Conclusion: Non-enhanced 3D-TOF-MRA is useful to assess the spectrum of angiographic abnormalities early in the course of illness. It can be used to predict the outcome of the disease in relation to vascular complications.

 

Keywords: Non-Enhanced; 3D-TOF-MRA; Tuberculous; Angiographic

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References

  1. Global tuberculosis report 2012. World Health Organization (2013).
  2. Garg RK. “Classic diseases revisited: Tuberculosis of the Central Nervous System”. Postgraduate Medical Journal 75 (1999): 133-140.
  3. Singhi P and Singhi S. “Central Nervous System Tuberculosis”. Current Treatment Options in Infectious Diseases 3 (2001): 481-492.
  4. Jinkins JR. “Computed tomography of intracranial tuberculosis”. Neuroradiology 33 (1991): 126-135.
  5. Trivedi R., et al. “Magnetic resonance imaging in central nervous system tuberculosis”. Indian Journal of Radiology and Imaging 19 (2009): 256-265.
  6. Tandon PN., et al. “Tuberculous meningitis”. In: Vinken PJ, Bruyn GW, Klawans HZ, editors. Handbook of Clinical Neurology. Amsterdam: Elsevier 8 (1988): 196-226.
  7. Shah GV. “Central Nervous system tuberculosis: Imaging Manifestations”. Neuroimaging Clinics of North America2 (2000): 355-374.
  8. Lehrer H. “The angiographic triad in tuberculous meningitis: a radiographic and clinic-pathologic correlation”. Radiology 87 (1966): 829-835.
  9. Mathew N., et al. “Cerebral angiography features in tuberculous meningitis”. Neurology 20 (1970): 1015-1023.
  10. Dalal PM. “Observations on the involvement of cerebral vessels in tuberculous meningitis in adults”. Advances in Neurology 25 (1979): 149-159.
  11. Leeds NE and Goldberg HI. “Angiographic manifestations in cerebral inflammatory disease”. Radiology 98 (1971): 595-604.
  12. Rojas-Echeverri LA., et al. “Predictive value of digital subtraction angiography in patients with Tuberculous meningitis”. Neuroradiology 38 (1996): 20-24.
  13. Schneider G., et al. “Magnetic Resonance Angiography: Techniques, Indications and Practical applications”. Milan: Springer (2005): 103-138.
  14. Bash S., et al. “Intracranial Vascular Stenosis and Occlusive Disease: Evaluation with CT Angiography, MR Angiography, and Digital Subtraction Angiography”. American Journal of Neuroradiology 26 (2005): 1012-1021.
  15. Gupta RK., et al. “MR imaging and angiography in tuberculous meningitis”. Neuroradiology 36 (1994): 87-92.
  16. Appenzeller S., et al. “Vascular involvement of the central nervous system and systemic diseases: etiologies and MRI findings”. Rheumatology International 28 (2008): 1229-1237.
  17. Kalita J., et al. “MR angiography in tuberculous meningitis”. Acta Radiologica 53 (2012): 324-329.
  18. Kalita J., et al. “Tuberculous meningitis with pulmonary miliary TB. A clinicoradiological study”. Neurology India2 (2004): 194-196.
  19. Misra UK., et al. “Role of clinical radiological and neurophysiological changes in predicting the outcome of tuberculous meningitis: a multivariable analysis”. Journal of Neurology, Neurosurgery, and Psychiatry 68 (2000): 300-303.
  20. Teasdale G and Jennett B. “Assessment of coma and impafired consciousness”. Lancet (1974): 81-84.
  21. Medical research council. “Streptomycin treatment of tuberculous meningitis”. Lancet 1 (1948): 582-585.
  22. Jennett B and Bond M. “Assessment of outcome after severe brain damage”. Lancet 1 (1957): 480-489.
  23. Dastur DK., et al. “The brain and meninges in tuberculous meningitis-gross pathology in 100 cases and pathogenesis”. Neurology India 18 (1970): 86-100.
  24. Volgl TJ., et al. “MR angiography in children with cerebral neurovascular diseases”. American Journal of Roentgenology 159 (1992): 817-823.
  25. Koelfen W., et al. “Magnetic resonance angiography in 140 neuropediatric patients”. Pediatric Neurology 12 (1995): 31-38.
  26. Wiznitzer M and Masaryk TJ. “Cerebrovascular abnormalities in pediatric stroke: assessment using parenchymal and angiographic magnetic resonance imaging”. Annals of Neurology 29 (1991): 585–589.
  27. Maas K., et al. “Selected indications for and applications of magnetic resonance angiography in children”. Pediatric Neurosurgery 20 (1994): 113-125.
  28. Zimmerman RA., et al. “Pediatric magnetic resonance angiography: assessment of stroke”. CardioVascular and Interventional Radiology 15 (1992): 60-64.
  29. Gujjar AR., et al. “HHH Regime for Arteritis Secondary to TB Meningitis: A Prospective Randomized Study”. Neurocritical Care 10 (2009): 313-317.
  30. Kalita J., et al. “Predictors of stroke and its significance in the outcome of tuberculous meningitis”. Journal of Stroke and Cerebrovascular Diseases 18 (2009): 251-258.
  31. Misra UK., et al. “Role of aspirin in tuberculous meningitis: a randomized open label placebo controlled trial”. Journal of the Neurological Sciences 293 (2010): 12-17.
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Citation

Citation: Chatterjee P., et al. “Non-Enhanced 3D-TOF-MRA Evaluation in Tuberculous Meningitis and Correlation of Angiographic Abnormalities with Clinical Outcome". Acta Scientific Neurology 5.6 (2022): 52-61.




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