We report on a 14 y/o HIV-negative girl with diagnosis of miliary tuberculosis (meningitis and pulmonary disease) who presented with right hemichorea three weeks after initiation of prednisone, rifampin, isoniazide, pyrazinamide and ethambutol. Brain MRI showed ischemic lesions in left caudate and lenticulo-capsular area ( Figure ). Hemichorea is a rare neurological manifestation of tuberculosis 11 . Alarcón F, Duenãs G, Cevallos N, Lees AJ. Movement disorders in 30 patients with tuberculous meningitis. Mov Disord 2000;15:561-569. . Basal ganglia infarcts caused by vasculitis probably decreased the GABAergic transmission in indirect basal ganglion pathway causing hemichorea. The major differential diagnoses in acquired hemichorea are Sydenham’s chorea, nonketotic hyperglycemia and cerebral toxoplasmosis 22 . Wild EJ, Tabrizi SJ. The differential diagnosis of chorea. Pract Neurol 2007;7:360-373. . We emphasize the importance of brain MRI in the diagnostic evaluation of these patients.
. Coronal T2-weighted image shows hyperintensity in the left head of the caudate and lenticular nucleus (A). Axial T1- weighted image with gadolinium shows enhancement without mass effect in left lenticular nucleus, suggestive of subacute ischemic injury (B). Axial diffusion-weighted image (DWI) and axial apparent diffusion coefficient (ADC) map show restricted diffusion compatible with acute ischemic injury (C, D). Axial T1- weighted image with gadolinium shows a lacunar infarct in left internal capsule consistent with chronic ischemic injury. These changes are compatible with ischemic lesions in different stages (E).
References
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1Alarcón F, Duenãs G, Cevallos N, Lees AJ. Movement disorders in 30 patients with tuberculous meningitis. Mov Disord 2000;15:561-569.
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2Wild EJ, Tabrizi SJ. The differential diagnosis of chorea. Pract Neurol 2007;7:360-373.
Publication Dates
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Publication in this collection
Mar 2014
History
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Received
22 July 2013 -
Reviewed
29 Sept 2013 -
Accepted
08 Oct 2013
