Department of Neurological, Neuropsychological, Morphological and Movement Sciences. Section of Clinical Neurology. University of Verona, Italy, Department of Neurology, Franz Tappeiner Hospital, Merano, Italy, Radiology Department, Children's Hospital of Pittsburgh at the University of Pittsburgh Medical Center, USA, Department of Neurology, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
Seizures may frequently occur during tuberculous meningitis. We describe a patient with an apparent generalised tonic-clonic seizure, initially not associated with any magnetic resonance imaging (MRI) abnormality, which was the presenting symptom of tuberculous meningitis. Follow-up MRI, performed after gadolinium administration, showed signs of meningeal involvement. Seizures may be the presenting symptoms of tuberculous meningitis even in the absence of evident intracerebral lesions on MRI. Therefore, contrast-enhanced brain MRI should be performed in the diagnostic workup for each first seizure, especially in patients with a clinical suspicion of CNS infectious disease. The term “heraldic seizure”, indicating a subset of acute symptomatic seizures presenting at the onset of a brain/systemic injury or preceding the full clinical manifestation of a cerebral insult, may be helpful to classify these seizures retrospectively, based initially on unknown aetiology.