Extensive Vasculitis in Tuberculous Meningitis

Tuberculous meningitis causes substantial morbidity and mortality in tropical countries. The various complications reported are hydrocephalus, vasculitic infarcts, tuberculomas, abscesses, and optochiasmatic arachnoiditis. Vasculitis in tuberculosis is basically at the level of lenticulostriate arteries supplying the basal ganglia and terminal cortical branches. In this case report, we present a rare case of tuberculous meningitis with extensive vasculopathy. During hospitalization, she developed acute onset right-sided classical hemiplegia with the inability to speak due to left internal carotid artery occlusion on imaging. The cerebrospinal fluid depicted very high protein levels. The exact pathogenesis of such extensive involvement in tuberculous meningitis substantiates the need for further studies.