저자들은 속립성 폐결핵과 연관되어 급성 경과를 보인 결핵성 뇌수막뇌염 환자에서 뇌혈관 자기공명영상으로 혈관염 소견을 확인하고, 스테로이드의 투여와 중단, 재투여에 따라 뇌증의 증세가 뚜렷히 변하는 임상경과, 증상이 호전된 후 추적한 뇌혈관 자기공명영상에서 혈관 영상이 정상화된 것을 확인할 수 있었던 사례를 경험하였기에 문헌고찰과 함께 보고하는 바이다.
Intracranial vasculitis is a rare and disastrous complication of tuberculous meningitis if not treated properly. Focal neurologic deficits according to the vessels involved are common manifestation. Here, we report a 29-year-old man who suffered abrupt, bizarre behavioral changes caused by vasculitis complicating tuberculous meningoencephalitis. The diagnosis of tuberculous meningitis is based upon both the CSF findings and a chest X-ray. His systemic symptoms disappeared by after being administered antituberculous medication but various psychotic features such as hypersomnia, hyperphagia and aggressive behavior continued. A brain MRI showed multiple small parenchymal tuberculous nodules, and the brain MR angiography revealed a narrowing of the proximal middle cerebral arteries and a reduced visualization of the cerebral vessels, suggesting widespread vasculitis. Intravenous dexamethasone successfully ameliorated his behavioral changes. In addition both the follow up brain MRI and angiography showed a normalization of the previous findings.
