Ischemic stroke due to tuberculosis in an uncommon arterial territory: A case report and literature review

Tuberculous meningitis (TBM) is a severe form of tuberculosis that can lead to complications such as stroke, occurring in 13%-57% of cases. This report describes a 21-year-old man with no prior medical history who presented with headache, fever, and vomiting, followed by visual hallucinations, impaired alertness, and speech disturbances. Initial CT imaging revealed bilateral hypodense frontal lesions with poor contrast enhancement, and cerebrospinal fluid analysis indicated lymphocytic meningitis. MRI demonstrated bilateral parasagittal frontal signal abnormalities extending to the knee of the corpus callosum with leptomeningeal enhancement, while angiographic sequences showed occlusion of the left anterior cerebral artery and thinning of the distal right anterior cerebral artery, leading to a diagnosis of ischemic stroke secondary to TBM. Stroke in TBM patients may be asymptomatic or present with focal neurological deficits, and MRI with angiographic sequences is essential for identifying ischemic changes and vascular involvement suggestive of vasculitis. Although no targeted therapy exists for stroke in TBM, timely diagnosis and initiation of standard anti-tuberculosis treatment with supportive care are crucial. This case highlights the need for early neuroimaging in TBM to detect stroke and mitigate long-term neurological complications.