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All Journal Jurnal Neuroanestesi Indonesia Acta Neurologica Indonesia
Kustila, Ela
Unknown Affiliation
Biochemistry, Genetics & Molecular Biology Education Medicine & Pharmacology Neuroscience Public Health

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Multiple Large Cerebral Infactions in Tuberculous Meningitis: A Rare Case Kustila, Ela; Dian, Sofiati
Jurnal Neuroanestesi Indonesia Vol 14, No 3 (2025)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v14i3.688

Abstract

Cerebral infarction is well known as a consequence arising from tuberculous meningitis (TBM), which generally involves the small and medium-sized intracranial arteries. These infarcts are usually located in regions termed the “TB zone,” perfused by the medial striate and thalamo-perforating arteries, and in the “ischemic zone,” supplied by the lateral striate, anterior choroidal, and thalamogeniculate arteries. In contrast, the involvement of larger arteries is an uncommon feature of tuberculous vasculitis. We report the case of a 24-year-old man with TBM and pulmonary tuberculosis, without HIV infection, who developed loss of consciousness after undergoing a ventriculoperitoneal (VP) shunt procedure. Neuroimaging with computed tomography (CT) revealed extensive cerebral edema accompanied by massive infarctions involving the cerebellum, cerebral hemispheres, and brainstem. These findings illustrate an unusual presentation of multiple large cerebral infarctions associated with TBM. Such extensive infarcts represent severe complications that can be resulted in profound neurological deficits. This case underscores the importance of early recognition and management of TBM-related complications. Prompt initiation of antituberculosis therapy is essential to reduce the risk of fatal outcomes. Moreover, further investigations are warranted to establish more effective therapeutic approach and optimize patient prognosis
Acute Ischemic Stroke in Moyamoya Disease: A Case Report Kustila, Ela
Acta Neurologica Indonesia Vol. 2 No. 02 (2024): Acta Neurologica Indonesia
Publisher : Departemen Neurologi Fakultas Kedokteran Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69868/ani.v2i02.30

Abstract

Introduction: Moyamoya disease (MMD) is also known as spontaneous occlusion of the circle of Willis, is a chronic, occlusive cerebrovascular disease with an unknown etiology.1 It is characterized by progressive stenosis or occlusions of the intracranial internal carotid artery (IAC) and or the proximal portion of the anterior cerebral artery (ACA) and middle cerebri artery (MCA).1,2 This steno-occlusive pattern is associated with a compensatory development of a collateral network of vessels at the base of the brain, appearing as a “puff of smoke” on conventional angiography ( “moyamoya” in Japanese).1,2 The clinical presentations of MMD include transient ischemic attacks, ischemic strokes, hemorrhagic strokes, seizure, headache, and cognitive impairment.1,2,3 Case Report: This case study presents a 48-year-old male with symptoms hemiparesis sinistra. Brain CT scan result was subacute infarct at right anterior cerebri artery territory. Digital Substract Angiography (DSA) result was occlusion in the right media cerebri artery (MCA) and right anterior cerebri artery (ACA), severe stenosis right verterbral artery until basilar artery, moyamoya vessels at anterior and posterior circulation.
Co-Authors Sofiati Dian