Ischemic Stroke: A Complication of Tuberculous Meningitis

We report a case of a 45-year old Hispanic male who was diagnosed with tuberculous meningitis (TBM) presented to the emergency department (ED) with altered mental status, confusion, and violent behavior. Computed tomography (CT) scan of the head was normal and repeated lumbar puncture (LP) did not yield new findings. Magnetic resonance imaging (MRI) of head showed multiple ischemic infarcts. Non-tPA stroke protocol was followed and anti-TB medicines were continued. With continuous cardiac monitoring, echocardiogram (ECHO) was normal so arrhythmia was less likely. Soon he was more responsive and alert with no further episodes of agitation and behavioral changes. Then, he was able to walk with assistance and was discharged to acute rehabilitation facility.