{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T17:02:25Z","timestamp":1773853345757,"version":"3.50.1"},"reference-count":19,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T00:00:00Z","timestamp":1773792000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Reports"],"abstract":"<jats:p>Background: Tuberculous meningitis (TBM) is the most severe manifestation of tuberculosis in children, with high mortality rates and long-term neurological sequelae. Early diagnosis is challenging due to its nonspecific symptoms and insidious onset. Case Presentation: An 8-year-old previously healthy male, fully vaccinated, presented with a two-week history of fever, headache, vomiting, and abdominal pain. Cerebrospinal fluid (CSF) analysis revealed lymphocytic pleocytosis, elevated protein, and low glucose levels, while multiplex polymerase chain reaction (PCR) testing for bacteria and viruses yielded negative results. Brain computed tomography (CT) revealed mild ventricular dilation and pansinusitis. Empirical antibacterial and antiviral therapy were initiated; however, the patient subsequently experienced neurological deterioration, including cranial nerve deficits and hemiparesis. Brain magnetic resonance imaging (MRI) demonstrated acute infarctions of the basal ganglia, raising suspicion for TBM. Repeated CSF sampling and Xpert MTB\/RIF assay confirmed infection with Mycobacterium tuberculosis. Anti-tuberculosis treatment was initiated in combination with adjunctive corticosteroids, anticonvulsant and anticoagulant therapies, and supportive care, including neurosurgical intervention for hydrocephalus. After 16 months of treatment, the patient showed clinical improvement but sustained left-sided hemiparesis, visual impairment, and cognitive deficits. Conclusions: This case highlights the diagnostic challenges of pediatric TBM in immunocompetent and Bacillus Calmette\u2013Gu\u00e9rin (BCG)-vaccinated children, particularly in the presence of initially negative microbiological findings. It emphasizes the importance of maintaining a high index of clinical suspicion and the crucial supportive role of neuroimaging findings, as well as the earlier initiation of empirical TB therapy especially when epidemiological plausibility exists. Early recognition and intervention remain critical to reducing morbidity and mortality associated with this devastating disease.<\/jats:p>","DOI":"10.3390\/pediatric18020044","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T10:11:12Z","timestamp":1773828672000},"page":"44","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Basal Ganglia Ischemic Stroke as Sentinel Sign for Pediatric Tuberculous Meningitis in an Immunocompetent Child: A Case Report"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2294-0787","authenticated-orcid":false,"given":"Albina","family":"Ponosheci Bi\u00e7aku","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Faculty of Medicine, University of Prishtina, Str. Bulevardi i D\u00ebshmor\u00ebve, 10000 Prishtina, Kosovo"},{"name":"Clinic of Infectious Diseases, University Clinical Center of Kosovo, Lagjia Spitalit, 10000 Prishtina, Kosovo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3399-6428","authenticated-orcid":false,"given":"Kurtesh","family":"Sherifi","sequence":"additional","affiliation":[{"name":"Faculty of Agriculture and Veterinary, University of Prishtina, Str. Bill Clinton, 10000 Prishtina, Kosovo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1809-6018","authenticated-orcid":false,"given":"Ardian","family":"Bi\u00e7aku","sequence":"additional","affiliation":[{"name":"Clinic of Radiology, University Clinical Center of Kosovo, Lagjia Spitalit, 10000 Prishtina, Kosovo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2411-8623","authenticated-orcid":false,"given":"Sadije","family":"Namani","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Faculty of Medicine, University of Prishtina, Str. Bulevardi i D\u00ebshmor\u00ebve, 10000 Prishtina, Kosovo"},{"name":"Clinic of Infectious Diseases, University Clinical Center of Kosovo, Lagjia Spitalit, 10000 Prishtina, Kosovo"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Huynh, J., Abo, Y.N., du Preez, K., Solomons, R., Dooley, K.E., and Seddon, J.A. (2021). Tuberculous Meningitis in Children: Reducing the Burden of Death and Disability. Pathogens, 11.","DOI":"10.3390\/pathogens11010038"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"100164","DOI":"10.1016\/j.jctube.2020.100164","article-title":"Challenges in the diagnosis of tuberculous meningitis","volume":"20","author":"Palacios","year":"2020","journal-title":"J. Clin. Tuberc. Other Mycobact. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"175","DOI":"10.3390\/pediatric14020024","article-title":"A Fatal Case of Tuberculosis Meningitis in Previously Health Children","volume":"14","author":"Colosimo","year":"2022","journal-title":"Pediatr. Rep."},{"key":"ref_4","first-page":"000193","article-title":"Neuro-TB: The Battle between Tuberculosis and the Nervous System","volume":"9","author":"Saumya","year":"2025","journal-title":"J. Infect. Dis. Travel Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/j.neurol.2019.07.007","article-title":"Tuberculous meningitis: Challenges in diagnosis and management","volume":"175","author":"Bouchaud","year":"2019","journal-title":"Rev. Neurol."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Sava, C., Sava, M., Dragan, A.M., Iuhas, A., Niulas, L., Marinau, C.P., and Balmos, A.B. (2023). The Use of XpertMTB\/RIF Ultra Testing for Early Diagnosis of Tuberculosis: A Retrospective Study from a Single-Center Database. Genes, 14.","DOI":"10.3390\/genes14061231"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e0191","DOI":"10.1097\/MD9.0000000000000191","article-title":"Ischemic stroke in an adolescent as a sequelae of smear negative tuberculous meningitis: A case report from endemic setting","volume":"2","author":"Acharya","year":"2021","journal-title":"Med. Case Rep. Study Protoc."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"du Preez, K., Jenkins, H.E., Donald, P.R., Solomons, R.S., Graham, S.M., Schaaf, H.S., Starke, J.R., Hesseling, A.C., and Seddon, J.A. (2022). Tuberculous Meningitis in Children: A Forgotten Public Health Emergency. Front. Neurol., 13.","DOI":"10.3389\/fneur.2022.751133"},{"key":"ref_9","first-page":"1","article-title":"Duration of Cyto-biochemical changes in CSF in children with TB Meningitis","volume":"7","author":"Namani","year":"2009","journal-title":"Internet J. Infect. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1186\/s13256-017-1347-7","article-title":"Tuberculous meningoencephalitis associated with brain tuberculomas during pregnancy: A case report","volume":"11","author":"Namani","year":"2017","journal-title":"J. Med. Case Rep."},{"key":"ref_11","unstructured":"Kosovo Agency of Statistics (2026, March 09). Statistikat e Sh\u00ebndet\u00ebsis\u00eb. Available online: https:\/\/askapi.rks-gov.net\/Custom\/d96bb22b-6b14-420c-a4e0-097928f283f0.pdf."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1111\/tmi.13525","article-title":"Diagnostic accuracy of Xpert MTB\/RIF for tuberculous meningitis: Systematic review and meta-analysis","volume":"26","author":"Hernandez","year":"2021","journal-title":"Trop. Med. Int. Health"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2625","DOI":"10.1007\/s00381-021-05163-2","article-title":"Risk factors for ischemic stroke in children with tuberculous meningitis","volume":"37","author":"Solomons","year":"2021","journal-title":"Child\u2019s Nerv. Syst."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Manyelo, C.M., Chegou, N.N., Seddon, J.A., Snyders, C.I., Mutavhatsindi, H., Manngo, P.M., Walzl, G., Stanley, K., and Solomons, R.S. (2021). Serum and cerebrospinal fluid host proteins indicate stroke in children with tuberculous meningitis. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0250944"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1017\/cjn.2020.265","article-title":"High-Resolution Vessel Wall MRI as a Complementary Investigation for CNS Tuberculosis","volume":"48","author":"Feitoza","year":"2021","journal-title":"Can. J. Neurol. Sci."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"100508","DOI":"10.1016\/j.jctube.2024.100508","article-title":"Tuberculous meningitis-related ischemic stroke: A retrospective study from a tertiary care hospital","volume":"38","author":"Deng","year":"2024","journal-title":"J. Clin. Tuberc. Other Mycobact. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Wang, Y., Xu, Z., Xu, D., and Hou, D. (2026). Quantitative ASL Perfusion and Vessel Wall MRI in Tuberculous Meningitis: A Pre- and Post-Treatment Study. J. Clin. Med., 15.","DOI":"10.3390\/jcm15020424"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1093\/cid\/ciab982","article-title":"TB Meningitis Study Group. Treatment and Outcome in Children with Tuberculous Meningitis: A Multicenter Pediatric Tuberculosis Network European Trials Group Study","volume":"75","author":"Thee","year":"2022","journal-title":"Clin. Infect. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1002\/cpt.202","article-title":"Pediatric tuberculous meningitis: Model-based approach to determining optimal doses of the anti-tuberculosis drugs rifampin and levofloxacin for children","volume":"98","author":"Savic","year":"2015","journal-title":"Clin. Pharmacol. 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