CEREBRAL VENOUS THROMBOSIS DURING TUBERCULOUS MENINGOENCEPHALITIS: A RARE CASE IN THE ICU

Cerebral venous thrombosis is an uncommon neurovascular complication, marked by significant clinical and etiological heterogeneity. Infectious causes account for fewer than 10% of cases, with tuberculous involvement of the central nervous system representing an exceptional etiology.We report the case of a 25-year-old patient presenting with febrile impaired consciousness and anisocoria, in whom the medical history revealed close contact with a confirmed case of tuberculosis. Initial laboratory investigations and cerebrospinal fluid analysis were highly suggestive of tuberculous infection of the central nervous system, despite the absence of Mycobacterium tuberculosis isolation from CSF. Cerebral MR angiography demonstrated findings consistent with tuberculous meningoencephalitis complicate by cerebral venous thrombosis. Management included initial stabilization, endotracheal intubation followed by tracheostomy, anti tuberculosis therapy, and full dose anticoagulation. Clinical evolution was favorable, with progressive neurological recovery. This case highlights the rarity and diagnostic complexity of the coexistence of tuberculous meningoencephalitis and cerebral venous thrombosis, and underscores the need for prompt, comprehensive management combining anti-tuberculosis treatment, corticosteroid therapy, and anticoagulation.