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OBJECTIVE: This retrospective study aimed to describe a cohort of 38 pediatric patients with MOGAD and to investigate the clinical differences between patients with CSF-negativity and CSF-positivity for MOG-abs. METHODS: The clinical and laboratory characteristics of pediatric patients with MOGAD were retrospectively studied. Demographics, clinical characteristics, CSF analysis, treatments and prognosis of patients were recorded. All patients' serums and CSF were tested for MOG-IgG by live cell-based assays (CBA). The data were statistically analysed. RESULTS: A total of 38 pediatric MOGAD patients were enrolled in the study, including 22 (57.9 %) females and 16 male (42.1 %) with a mean age of 8.4 ± 4.0 years at disease onset. Twenty-seven (71.7 %) patients were CSF-positive for MOG-abs while 11 (28.9 %) patients were CSF-negative for MOG-abs. The median follow-up was 25.5 months (IQR 5.5-73.25). Seventeen (44.7 %) patients presented a relapsing disease course, and the majority of these patients was CSF positive with a significant difference between the two groups (p = 0.038) in terms of recurrent diseases. CSF-positive patients presented more often an increased white cell count (p = 0.043), and in this cohort clinical phenotypes with spinal involvement were more frequent while encephalitis-like phenotypes were more frequent in the CSF negative cohort (p = 0.019). CONCLUSIONS: CSF-status appears to identify two subgroups in this pediatric MOGAD population; thus, CSF-status requires further studies in pediatric patients with MOGAD.
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Autoanticuerpos , Glicoproteína Mielina-Oligodendrócito , Humanos , Masculino , Femenino , Glicoproteína Mielina-Oligodendrócito/inmunología , Glicoproteína Mielina-Oligodendrócito/líquido cefalorraquídeo , Niño , Autoanticuerpos/líquido cefalorraquídeo , Autoanticuerpos/sangre , Estudios Retrospectivos , Preescolar , Adolescente , Estudios de Seguimiento , Relevancia ClínicaRESUMEN
Our knowledge of the radiological spectrum of myelin oligodendrocyte glycoprotein antibody associated disease (MOGAD) is growing rapidly. An update on the radiological features of the disease, and its evolution is thus necessary. Magnetic resonance imaging (MRI) has an increasingly important role in the differential diagnosis of MOGAD particularly from aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder (AQP4-NMOSD), and multiple sclerosis (MS). Differentiating these conditions is of prime importance because the management is different between the three inflammatory diseases, and thus could prevent further attack-related disability. Therefore, identifying the MRI features suggestive of MOGAD has diagnostic and prognostic implications. We herein review optic nerve, spinal cord and the brain MRI findings from MOGAD adult patients, and compare them to AQP4-NMOSD and MS.
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Imagen por Resonancia Magnética , Adulto , Acuaporina 4 , Autoanticuerpos , Humanos , Glicoproteína Mielina-Oligodendrócito , Neuromielitis Óptica/diagnóstico por imagenRESUMEN
INTRODUCTION: While monophasic and relapsing forms of myelin oligodendrocyte glycoprotein antibody associated disorders (MOGAD) are increasingly diagnosed world-wide, consensus on management is yet to be developed. OBJECTIVE: To survey the current global clinical practice of clinicians treating MOGAD. METHOD: Neurologists worldwide with expertise in treating MOGAD participated in an online survey (February-April 2019). RESULTS: Fifty-two responses were received (response rate 60.5%) from 86 invited experts, comprising adult (78.8%, 41/52) and paediatric (21.2%, 11/52) neurologists in 22 countries. All treat acute attacks with high dose corticosteroids. If recovery is incomplete, 71.2% (37/52) proceed next to plasma exchange (PE). 45.5% (5/11) of paediatric neurologists use IV immunoglobulin (IVIg) in preference to PE. Following an acute attack, 55.8% (29/52) of respondents typically continue corticosteroids for ≥ 3 months; though less commonly when treating children. After an index event, 60% (31/51) usually start steroid-sparing maintenance therapy (MT); after ≥ 2 attacks 92.3% (48/52) would start MT. Repeat MOG antibody status is used by 52.9% (27/51) to help decide on MT initiation. Commonly used first line MTs in adults are azathioprine (30.8%, 16/52), mycophenolate mofetil (25.0%, 13/52) and rituximab (17.3%, 9/52). In children, IVIg is the preferred first line MT (54.5%; 6/11). Treatment response is monitored by MRI (53.8%; 28/52), optical coherence tomography (23.1%; 12/52) and MOG antibody titres (36.5%; 19/52). Regardless of monitoring results, 25.0% (13/52) would not stop MT. CONCLUSION: Current treatment of MOGAD is highly variable, indicating a need for consensus-based treatment guidelines, while awaiting definitive clinical trials.
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Autoanticuerpos , Inmunoglobulinas Intravenosas , Adulto , Niño , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Glicoproteína Mielina-Oligodendrócito , Plasmaféresis , Encuestas y CuestionariosRESUMEN
Multiple Sclerosis (MS) is the commonest among inflammatory demyelinating diseases. While the disease prevalence is high in adults, frequency of pediatric onset multiple sclerosis (POMS) is very low in children and particularities in this population have been identified. We will address in this review characteristics of POMS.
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Esclerosis Múltiple/diagnóstico , Esclerosis Múltiple/epidemiología , Pediatría , Adulto , Edad de Inicio , Niño , Humanos , Esclerosis Múltiple/terapia , Pediatría/métodos , Pediatría/estadística & datos numéricos , PrevalenciaRESUMEN
BACKGROUND AND PURPOSE: Acute disseminated encephalomyelitis followed by optic neuritis (ADEM-ON) is a rare demyelinating syndrome that is different from multiple sclerosis and neuromyelitis optica spectrum disorder. The aim of this study was to describe the disease course, treatment response and outcome of children with ADEM-ON. METHODS: Children of <18 years of age were identified from six countries of the EU Paediatric Demyelinating Disease Consortium. Patients fulfilled the diagnostic criteria for ADEM followed by at least one ON. Anti-myelin oligodendrocyte glycoprotein (MOG) antibodies were tested in all patients. RESULTS: In this study of 17 patients (nine boys) with ADEM-ON, anti-myelin oligodendrocyte glycoprotein (MOG) antibodies were identified in 16 patients. Age at onset was 6.1 years (interquartile range, 5.1-9.2 years). Twelve patients received oral prednisolone and 10 received maintenance immunosuppression (e.g. azathioprine, intravenous immunoglobulins, Rituximab). During a follow-up of 5.3 years (interquartile range, 1.8-10.2 years), 54 relapses occurred with a median of 3 relapses per patient (range, 1-9 per patient). Patients relapsed on all treatments but no relapses occurred on a prednisolone dose >10 mg/day. Visual and cognitive residual deficits were common in this group. CONCLUSIONS: Acute disseminated encephalomyelitis followed by optic neuritis is an anti-MOG antibody-associated relapsing disorder that can have a heterogeneous disease course. Patients were refractory for maintenance immunosuppression and appeared to be corticosteroid-dependent. Further international collaborations are now required to unify guidelines in this difficult-to-manage group of patients.
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Encefalomielitis Aguda Diseminada/diagnóstico , Inmunoglobulinas Intravenosas/uso terapéutico , Inmunosupresores/uso terapéutico , Neuritis Óptica/diagnóstico , Adolescente , Autoanticuerpos , Azatioprina/uso terapéutico , Niño , Preescolar , Progresión de la Enfermedad , Encefalomielitis Aguda Diseminada/tratamiento farmacológico , Encefalomielitis Aguda Diseminada/inmunología , Femenino , Humanos , Masculino , Glicoproteína Mielina-Oligodendrócito/inmunología , Neuritis Óptica/tratamiento farmacológico , Neuritis Óptica/inmunología , Prednisolona/uso terapéutico , Rituximab/uso terapéutico , Resultado del TratamientoRESUMEN
Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by thunderclap headaches with diffuse segmental constriction of cerebral arteries that resolves spontaneously within 3 months. We report on a case of a 13-year-old boy presenting with acute severe headaches, triggered by physical exertion. His past medical history was uneventful. Moderate headache persisted between exacerbations for 4 weeks. He secondarily presented with signs of intracranial hypertension. Brain magnetic resonance angiography (MRA) revealed multifocal narrowing of the cerebral arteries. A glucocorticoid treatment was started based on the hypothesis of primary angiitis of the CNS. The symptoms rapidly improved, and repeat angiography at 3 months showed no vasoconstriction. Although pediatric cases are rare, RCVS should be considered in a child complaining of severe headache, especially after the use of vasoactive drugs or after Valsalva manoeuvres. RCVS is attributed to a transient, reversible dysregulation of cerebral vascular tone, which leads to multifocal arterial constriction and dilation. Physical examination, laboratory values, and initial cranial computed tomography are unremarkable, except when RCVS is associated with complications. Thunderclap headaches tend to resolve and then recur over a 1- to 4-week period, often with a milder baseline headache persisting between acute exacerbations. Angiography shows segmental narrowing and dilatation of one or more arteries, like a string of beads. Despite the absence of a proven treatment, important steps should be taken during the acute phase: removal of precipitants such as vasoactive substances, giving the patient rest, lowering blood pressure, and controlling seizures. Drugs targeted at vasospasms, such as calcium channel inhibitors, can be considered when cerebral vasoconstriction has been assessed. In most patients, the RCVS symptoms resolve spontaneously within days or weeks. Ischemic and hemorrhagic stroke are the major complications of the syndrome. A diagnosis of RCVS can only be confirmed when the reversibility of the vasoconstriction is assessed.
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Encéfalo/irrigación sanguínea , Cefaleas Primarias/etiología , Vasoconstricción , Adolescente , Humanos , Hipertensión Intracraneal/etiología , Masculino , Esfuerzo FísicoRESUMEN
The objective of this paper is to: describe the phenotype compound heterozygote for mutations in CECR1 in two children. We describe the clinical and immunological phenotype, including the assessment of ADA2 activity, cytokine expression, interferon-stimulated and neutrophil-stimulated gene signatures, and the results of CECR1 sequencing. The first patient presented with intermittent fever, cutaneous vasculitis, myalgia and muscle inflammation on MRI leading to a provisional diagnosis of periarteritis nodosa. Subsequently, two cerebral lacunar lesions were identified following a brain stroke. Clinical features improved on anti-tumour necrosis factor therapy. The first patient's sister demonstrated early-onset, long-lasting anaemia with mild biological inflammation; at the ages of 3 and 5â years, she had presented 2 acute, transient neurological events with lacunar lesions on MRI. CECR1 sequencing identified both sisters to be compound heterozygous for a p.Tyr453Cys mutation and a previously undescribed deletion of exon 7. ADA2 activity was reduced by 50%. Neutrophil-stimulated genes were not overexpressed, but interferon-stimulated genes were. The expression of a panel of other cytokine transcripts was not significantly altered. In conclusion, searching for CECR1 mutation or assessing ADA2 activity should be considered in patients with an atypical presentation of inflammatory disease.
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Although less frequent than viral encephalitis, anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a frequent form of acute pediatric encephalitis. After a prodromal phase of flu-like symptoms, psychiatric symptoms predominate - agitation, anxiety, hallucinations - and can make correct diagnosis more difficult. Also noted are abnormal dyskinesia and dystonia-like movements, partial seizures, difficulties talking or memorizing, and autonomic manifestations. The presentation of two cases of anti-NMDAR encephalitis illustrates the symptoms of this disease. Although the CSF abnormalities are not highly specific of this disease, and MRI most often normal, EEG shows more specific signs. These observations enable us to discuss different treatment options and understand the progression of this disease.
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Encefalitis Antirreceptor N-Metil-D-Aspartato/diagnóstico , Encefalitis Antirreceptor N-Metil-D-Aspartato/inmunología , Autoanticuerpos/sangre , Receptores de N-Metil-D-Aspartato/inmunología , Encefalitis Antirreceptor N-Metil-D-Aspartato/tratamiento farmacológico , Encefalitis Antirreceptor N-Metil-D-Aspartato/epidemiología , Anticuerpos Monoclonales de Origen Murino/uso terapéutico , Encéfalo/patología , Niño , Preescolar , Estudios Transversales , Diagnóstico Diferencial , Quimioterapia Combinada , Electroencefalografía , Servicio de Urgencia en Hospital , Epilepsia Tónico-Clónica/etiología , Femenino , Francia , Humanos , Inmunización Pasiva , Imagen por Resonancia Magnética , Masculino , Metilprednisolona/uso terapéutico , Examen Neurológico , Valor Predictivo de las Pruebas , Síntomas Prodrómicos , RituximabRESUMEN
PURPOSE: Thrombosis of cerebral arteriovenous malformation after embolization is rare, but can involve the normal venous network with extensive venous thrombosis. We report angioarchitecture findings, our management and prevention strategy for this complication in pediatric AVMs. METHODS: In this 5.5-year retrospective series, we reviewed records of 13 patients under 15 years who were anticoagulated after embolization. In our initial experience 4 children who didn't receive any prophylactic anticoagulation presented with extensive venous thrombosis after embolization (group 1). Following this, nine children with similar angioarchitecture and embolization modalities were treated with prophylactic anticoagulation immediately after embolization (group 2). We analyzed the type of AVM, angioarchitecture, dose of prophylactic anticoagulant, efficacy/complications of treatment and late outcome. RESULTS: All patients in group 1 had severe jugular bulb stenosis/occlusion associated with cerebral venous dilatation. In group 2 with similar angioarchitecture, only three patients (33%) developed extensive thrombosis. In both groups, thrombosis occurred within two days of treatment in six children and two weeks in one child. The diagnosis was suspected on intracranial hypertension in five patients and occulomotor disorder in one. One was asymptomatic. All children were treated with therapeutic doses of LMWH (anti-Xa: 0.5-1). No hemorrhagic complications occurred. Good venous remodeling was observed in all but one patient. CONCLUSION: Anticoagulation in extensive venous thrombosis after AVM embolization in children appears to be safe and effective. In cases with angioarchitectural features of dilatation of the cerebral venous network and occlusion/severe stenosis of the jugular bulbs, full dose anticoagulation may be required to prevent thrombosis.
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Embolización Terapéutica/efectos adversos , Malformaciones Arteriovenosas Intracraneales/terapia , Trombosis Intracraneal , Malformaciones de la Vena de Galeno , Trombosis de la Vena , Anticoagulantes/uso terapéutico , Angiografía Cerebral , Niño , Preescolar , Constricción Patológica/complicaciones , Femenino , Humanos , Lactante , Malformaciones Arteriovenosas Intracraneales/complicaciones , Trombosis Intracraneal/complicaciones , Trombosis Intracraneal/etiología , Trombosis Intracraneal/prevención & control , Angiografía por Resonancia Magnética , Masculino , Pediatría , Estudios Retrospectivos , Tomógrafos Computarizados por Rayos X , Malformaciones de la Vena de Galeno/complicaciones , Malformaciones de la Vena de Galeno/etiología , Malformaciones de la Vena de Galeno/prevención & control , Trombosis de la Vena/complicaciones , Trombosis de la Vena/etiología , Trombosis de la Vena/prevención & controlRESUMEN
BACKGROUND: Acute transverse myelitis (ATM) in children is a rare and often severe disease for which there are few known prognostic factors, particularly the subsequent risk of multiple sclerosis (MS) diagnosis. OBJECTIVES: To determine the clinical course and prognostic factors after a first episode of ATM in children. METHODS: Thirty children below 16 years of age diagnosed with a first neurological episode of ATM were included retrospectively. Clinical evaluation, treatment, laboratory, and MRI data were collected. RESULTS: Median age at onset was 11 years (range 3-15 years). Follow-up data were available for a median of 4 years (range 0.5-16.7 years). Five patients subsequently had a diagnosis of MS (17%), which was associated with acute partial transverse myelitis (odds ratio 5; 95% confidence interval 2.3-11), with a 60% probability of having a relapse at five years (p < 0.01). The 2011 Verhey criteria correctly identified MS in children with the highest specificity (96%) and sensitivity (80%). CONCLUSION: Acute partial transverse myelitis and brain MRI abnormalities at initial presentation are significantly predictive of a subsequent diagnosis of MS in children with ATM. These findings suggest that closer brain MRI monitoring after acute partial transverse myelitis might make the earlier introduction of disease-modifying therapies possible.
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Encéfalo/patología , Esclerosis Múltiple/diagnóstico , Mielitis Transversa/diagnóstico , Médula Espinal/patología , Enfermedad Aguda , Adolescente , Edad de Inicio , Niño , Preescolar , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Esclerosis Múltiple/complicaciones , Mielitis Transversa/etiología , Pronóstico , Estudios Retrospectivos , RiesgoRESUMEN
BACKGROUND AND PURPOSE: Few published data are available concerning the risk of re-bleeding of spinal cord AVM after an hematomyelia and concerning the long-term clinical outcome. Our aim was to assess the risk of recurrence and long-term clinical outcome after hematomyelia in children with spinal cord AVMs. MATERIALS AND METHODS: This single-center retrospective study reviewed the clinical and radiologic data of 28 children younger than 18 years of age with arteriovenous malformation who had experienced at least 1 episode of hematomyelia between 1988 and 2012. Long-term clinical outcome was assessed by the American Spinal Injury Association Impairment Scale, and radiologic review included MR imaging and angioarchitecture on angiography (blinded to clinical information) before treatment and at recurrence. RESULTS: Sixteen children (57%) experienced 1 episode of hematomyelia, while 12 children (43%) experienced recurrence. Girls and boys were equally affected (sex ratio, 1:1), and mean clinical follow-up was 5.7 ± 4.4 years. The risk of recurrence was higher for AVMs of the cervical and upper thoracic spine, 12 (100%) versus 11 (69%) (P = .01). A high American Spinal Injury Association scale score at last follow-up was reported for 11 children (39%), and the risk of recurrence tended to be associated with poorer functional prognosis (7 [64%] versus 5 [29%], P = .07). At the time of recurrence, perimedullary venous drainage was the main factor associated with recurrence (P = .002). Occlusion rate ≥50% was associated with a decreased risk of recurrence (P = .047). CONCLUSIONS: In the present series, cervical and upper thoracic spinal cord AVMs and microarchitecture were predictive of the risk of hematomyelia recurrence. Perimedullary venous drainage was one of the main parameters associated with recurrence. Functional prognosis was better in patients with a single episode of hematomyelia.
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Malformaciones Arteriovenosas/diagnóstico por imagen , Malformaciones Arteriovenosas/epidemiología , Enfermedades Vasculares de la Médula Espinal/diagnóstico por imagen , Enfermedades Vasculares de la Médula Espinal/epidemiología , Médula Espinal/irrigación sanguínea , Médula Espinal/diagnóstico por imagen , Preescolar , Comorbilidad , Femenino , Francia/epidemiología , Humanos , Incidencia , Estudios Longitudinales , Masculino , Pronóstico , Radiografía , Recuperación de la Función , Recurrencia , Factores de RiesgoRESUMEN
INTRODUCTION: The potential of diffusion tensor imaging (DTI) to detect spinal cord abnormalities in patients with multiple sclerosis has already been demonstrated. The objective of this study was to apply DTI techniques to multiple sclerosis patients with a recently diagnosed spinal cord lesion, in order to demonstrate a correlation between variations of DTI parameters and clinical outcome, and to try to identify DTI parameters predictive of outcome. METHODS: A prospective single-centre study of patients with spinal cord relapse treated by intravenous steroid therapy was made. Patients were assessed clinically and by conventional MRI with DTI sequences at baseline and at 3 months. RESULTS: Sixteen patients were recruited. At 3 months, 12 patients were clinically improved. All but one patient had lower fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values than normal subjects in either inflammatory lesions or normal-appearing spinal cord. Patients who improved at 3 months presented a significant reduction in the radial diffusivity (p = 0.05) in lesions during the follow-up period. They also had a significant reduction in the mean ADC (p = 0.002), axial diffusivity (p = 0.02), radial diffusivity (p = 0.02) and a significant increase in FA values (p = 0.02) in normal-appearing spinal cord. Patients in whom the American Spinal Injury Association sensory score improved at 3 months showed a significantly higher FA (p = 0.009) and lower radial diffusivity (p = 0.04) in inflammatory lesion at baseline compared to patients with no improvement. CONCLUSION: DTI MRI detects more extensive abnormalities than conventional T2 MRI. A less marked decrease in FA value and more marked decreased in radial diffusivity inside the inflammatory lesion were associated with better outcome.
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Imagen de Difusión por Resonancia Magnética/métodos , Esclerosis Múltiple/diagnóstico , Esclerosis Múltiple/tratamiento farmacológico , Enfermedades de la Médula Espinal/diagnóstico , Enfermedades de la Médula Espinal/prevención & control , Esteroides/uso terapéutico , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Esclerosis Múltiple/complicaciones , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Enfermedades de la Médula Espinal/etiología , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVES: To differentiate onset of CNS involvement in primary hemophagocytic lymphohistiocytosis (HLH) from that of other CNS inflammatory diseases and to identify early symptoms linked to abnormal cognitive outcome. METHODS: Forty-six children with primary HLH who had neurologic evaluation within 2 weeks and brain MRI within 6 months of diagnosis were included. Initial symptoms, CSF study, brain MRI, and neurologic outcome were assessed. Brain MRIs were compared with those of 44 children with acute disseminated encephalomyelitis (ADEM). RESULTS: At disease onset, 29 children (63%) had neurologic symptoms and 7 (15%) had microcephaly. Twenty-three (50%) children had abnormal CSF study, but only 15 (33%) had abnormal brain MRI. The latter showed that patients with HLH, unlike patients with ADEM, had symmetric periventricular lesions, without thalamic and brainstem involvement and with infrequent hyposignal intensity on T1. At the end of follow-up (3.6 ± 3.6 years), 17 of the 28 (61%) surviving patients had normal neurologic status, 5 (18%) had a severe neurologic outcome, and 6 (21%) had mild cognitive difficulties. Abnormal neurologic outcome was not influenced by age or type of genetic defect, but by the presence of neurologic symptoms, MRI lesions, or abnormal CSF study at onset. Early clinical and MRI symptoms may regress after treatment. CONCLUSION: Neurologic symptoms are frequent at the onset of primary HLH and are mostly associated with abnormal CSF findings, but with normal brain MRI. In cases of abnormal brain MRI, the observed lesions differ from those of ADEM.
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Encéfalo/patología , Encéfalo/fisiopatología , Linfohistiocitosis Hemofagocítica/patología , Linfohistiocitosis Hemofagocítica/fisiopatología , Adolescente , Líquido Cefalorraquídeo/metabolismo , Niño , Preescolar , Trastornos de la Conciencia/etiología , Diagnóstico Diferencial , Encefalomielitis Aguda Diseminada/patología , Encefalomielitis Aguda Diseminada/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Lactante , Linfohistiocitosis Hemofagocítica/líquido cefalorraquídeo , Linfohistiocitosis Hemofagocítica/complicaciones , Linfohistiocitosis Hemofagocítica/psicología , Imagen por Resonancia Magnética , Masculino , Registros Médicos , Meningismo/etiología , Microcefalia/etiología , Microcefalia/patología , Microcefalia/fisiopatología , Estudios Retrospectivos , Convulsiones/etiología , Resultado del TratamientoAsunto(s)
Antiinflamatorios/administración & dosificación , Encefalomielitis Aguda Diseminada/tratamiento farmacológico , Unidades de Cuidado Intensivo Pediátrico , Metilprednisolona/administración & dosificación , Fármacos Neuroprotectores/administración & dosificación , Resucitación , Antivirales/uso terapéutico , Encéfalo/patología , Niño , Preescolar , Diagnóstico Diferencial , Encefalitis Viral/diagnóstico , Encefalitis Viral/tratamiento farmacológico , Encefalomielitis Aguda Diseminada/diagnóstico , Encefalomielitis Aguda Diseminada/etiología , Humanos , Lactante , Imagen por Resonancia Magnética , Examen Neurológico , Quimioterapia por PulsoRESUMEN
Tuberculous meningitis is uncommon in western countries and its outcome is poor when it is not diagnosed and treated in good time. Here, we present a case of febrile brain stroke revealing a tuberculous arachnoiditis in a 13-month-old infant living in a non-endemic country. Thanks to prompt specific antibiotherapy, the clinical outcome was globally favourable in spite of the occurrence of an asymptomatic brain tuberculoma, which disappeared spontaneously. Although tuberculous meningitis is rare in non-endemic countries, it must be evoked in strokes occurring in a febrile context.