Seizure heralding tuberculous meningitis |
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Authors: | Brigo Francesco Ausserer Harald Zuccoli Giulio Tezzon Frediano Nardone Raffaele |
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Affiliation: | Department of Neurological, Neuropsychological, Morphological and Movement Sciences. Section of Clinical Neurology. University of Verona, Italy, Department of Neurology, Franz Tappeiner Hospital, Merano, Italy. |
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Abstract: | Seizures may frequently occur during tuberculous meningitis. We describe a patient with an apparent generalised tonic-clonic seizure, initially not associated with any magnetic resonance imaging (MRI) abnormality, which was the presenting symptom of tuberculous meningitis. Follow-up MRI, performed after gadolinium administration, showed signs of meningeal involvement. Seizures may be the presenting symptoms of tuberculous meningitis even in the absence of evident intracerebral lesions on MRI. Therefore, contrast-enhanced brain MRI should be performed in the diagnostic workup for each first seizure, especially in patients with a clinical suspicion of CNS infectious disease. The term "heraldic seizure", indicating a subset of acute symptomatic seizures presenting at the onset of a brain/systemic injury or preceding the full clinical manifestation of a cerebral insult, may be helpful to classify these seizures retrospectively, based initially on unknown aetiology. |
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