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BMJ Case Reports 2012; doi:10.1136/bcr.02.2012.5807
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Acute tuberculous meningitis with fulminant fatal evolution in a 69-year-old man

  1. Tristan Ferry1,2,3
  1. 1Hospices Civils de Lyon, Lyon, France
  2. 2Université Claude Bernard, Lyon 1, France
  3. 3Pathogénie Bactérienne et Immunité Innée, INSERM U851, Lyon, France
  1. Correspondence to Dr Tristan Ferry, tristan.ferry{at}univ-lyon1.fr

Description

An immunocompetent (HIV-negative) 69-year-old Caucasian man with a history of paramedian pontine acute ischaemic stroke requiring intravenous thrombolysis 1 year earlier (ataxia as sequelae only) was admitted with a 7-day history of fever. The patient was in a confused state at admission, with known ataxia but without other neurological signs. His mental status worsened 4 days after admission with occurrence of a coma and neck stiffness. Mild hydrocephalus was observed on a first MRI (figure 1A), and ventriculoperitoneal shunt was not performed. Central nervous system tuberculosis was finally diagnosed (cerebrospinal fluid (CSF) …

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