A Combination of Moyamoya Pattern and Cerebral Venous Sinus Thrombosis: A Case of Tubercular Vasculopathy

J Trop Pediatr. 2015 Oct;61(5):393-6. doi: 10.1093/tropej/fmv036. Epub 2015 Jul 1.


Background: Moyamoya vasculopathy, arising secondary to tubercular meningitis (TBM) is unusual. There have also been a few reports of cerebral venous sinus thrombosis (CVST) in TBM. A case of TBM, complicated simultaneously by Moyamoya syndrome and CVST, is being presented here.

Case: A 1-year-old girl presented with febrile encephalopathy, vomiting, seizures and left hemiparesis. Cerebrospinal fluid analysis was suggestive of TBM. Extensive infarcts were noted in the magnetic resonance imaging, involving right middle cerebral artery (MCA), anterior cerebral artery and the left MCA. Magnetic resonance venogram revealed left transverse venous sinus thrombosis and magnetic resonance angiography showed bilateral moyamoya pattern of arteriopathy. Patient was started on antitubercular therapy and low molecular weight heparin.

Conclusions: Early vascular involvement affecting both arterial and venous structures has not hitherto been reported in CNS tuberculosis. Early recognition of secondary complications of CNS tuberculosis is crucial to prevent the morbidity and mortality associated with TBM.

Keywords: cerebral venous sinus thrombosis; moyamoya pattern; tubercular meningitis; tubercular vasculopathy.

Publication types

  • Case Reports

MeSH terms

  • Anticoagulants / administration & dosage
  • Anticoagulants / therapeutic use
  • Antitubercular Agents / administration & dosage
  • Antitubercular Agents / therapeutic use
  • Female
  • Heparin / administration & dosage
  • Heparin / therapeutic use
  • Humans
  • Infant
  • Magnetic Resonance Angiography
  • Magnetic Resonance Imaging
  • Middle Cerebral Artery
  • Moyamoya Disease / diagnosis*
  • Sinus Thrombosis, Intracranial / diagnosis*
  • Sinus Thrombosis, Intracranial / drug therapy
  • Treatment Outcome
  • Tuberculosis, Meningeal / diagnosis*
  • Tuberculosis, Meningeal / drug therapy


  • Anticoagulants
  • Antitubercular Agents
  • Heparin