Abstract Details

Tuberculous meningitis (TBM) causes significant morbidity and mortality. Among its complications, stroke is associated with poor clinical outcome.

We aimed to determine the country-specific, regional and overall frequencies of stroke among patients with TBM and identify the summary estimates of the clinical presentations, common locations of stroke, and outcomes.

We conducted a systematic review and meta-analysis that included randomized controlled trials and cohort studies involving a population of patients diagnosed with TBM and reported frequencies of stroke. We searched the following electronic databases, Pubmed, Embase and Scopus until July 2020.

From 852 articles identified, 71 studies involving 2,194 patients with stroke in TBM. The random-effect modeling analysis for the frequency of stroke in TBM showed an overall estimate of 0.30 [95% CI 0.26-0.33]. Various studies were conducted across the globe. The most common clinical manifestations included “fever” [0.86, 95% CI 0.68-0.94] and “headache” [0.76, 95% CI 0.62-0.90]. The usual vascular territories involved were the: lateral striate artery [0.55, 95% CI 0.35-0.76] and middle cerebral artery [0.37, 95% CI 0.21-0.53]. In terms of the areas affected by the stroke, the basal ganglia [0.60, 95% CI 0.44-0.75] cortex/ lobar [0.26, 95% CI 0.19-0.24] and internal capsule, [0.23, 95% CI 0.12-0.38] were reported. The proportions of mortality and  poor outcome 0.22 [95% CI 0.16-0.29] and 0.51 [95% CI 0.37-0.66], respectively.

This review showed that stroke has a high burden of disease among patients with TBM. The reported frequencies of stroke in TBM and its clinical features vary across the studies and populations.