Research Identifies Global Frequency Trends of Stroke in Patients with Tuberculous Meningitis

Marie Charmaine C. Sy, MD, MBA

According to new research, stroke occurrence trends in individuals with tuberculous meningitis (TBM) are suggested to have regional characteristics which investigators believe could be associated with disability and mortality in this patient population.

Because of the severe morbidity and mortality related to TBM, a team of investigators including Marie Charmaine C. Sy, MD, MBA, Division of Adult Neurology, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, sought out to determine the country-specific, regional, and overall prevalence of stroke in individuals living with the disease.

The infectious pathogen of TBM can navigate through the bloodstream so its effects extend beyond the lungs causing damage to any organ it infiltrates. The mycobacterium tuberculosis organism is the most prevalent cause for the infection, with investigators stating its reach makes up 10%-15% of all extrapulmonary manifestations. While the risks of TBM are serious regardless of location, those in developing countries are impacted the most.

The Systematic Review

MEDLINE by PubMed, Scopus, and EMBASE records were reviewed until July 2020 so investigators could document the occurrence and characteristics of the disease. The targets of the review focused on clinical manifestations, type of stroke, area of stroke, vascular territory, and outcomes in randomized clinical trials and cohort studies.

Additionally, investigators collected data on country-specific, regional, and overall frequencies of stroke among patients with tuberculous meningitis, with the secondary analysis including estimates of the clinical target information.A total of 71 articles with 2194 patients were included in the analysis following the review. The sample sizes ranged from 17-806 participating patients.

Global Prevalence and Clinical Characteristics

Based on these findings, patients with tuberculous meningitis showed a 0.30 estimated frequency of stroke with a range of 0.08 in Saudi Arabia to 0.56 in France. Overall, fever and headaches were the common clinical manifestations identified.

The primary vascular territories involved were the lateral striate, middle cerebral, and medial striate arteries, with the basal ganglia, cortex and lobar, and internal capsule representing the most frequently activated areas in the brain.

Data regarding the frequency of stroke in the East Asia and Pacific region revealed an estimate of 0.31 across 21 studies. Of these patients, 455 patients presented with stroke and 1489 total patients had TBM.

Estimates reported for Europe and Central Asia indicated a 0.17 prevalence among 12 studies, including 338 patients with stroke and 1843 total patients.

Pooled proportions of mortality and poor outcomes demonstrated a prevalence of 0.22 and 0.51, respectively.

“The results of this systematic review suggest that stroke is considerably frequent among patients with TBM," investigators concluded. "The reported frequencies of stroke in TBM and its clinical features vary across the studies and populations.”

The study, "Global Frequency and Clinical Features of Stroke in Patients with Tuberculous Meningitis: A Systematic Review" was published in JAMA.