[Ischemic cerebrovascular complication in tuberculous meningitis; a case of Fröhlich syndrome and hemiparesis].

A 34-year-old man came to our hospital with an episode of focal convulsion of the left arm. He had suffered from tuberculous meningitis in childhood and developed left hemiparesis and Fröhlich syndrome as sequelae. CT scan showed a calcified mass in the suprasellar cistern and a low density area suggestive of cerebral infarction in the right anterior cerebral artery distribution. The left carotid angiograms showed severe stenosis of the left internal carotid artery in the supra-clinoid segment and occlusion of the proximal middle and anterior cerebral arteries with development of moyamoya vessels as collateral circulation. The right carotid angiograms showed similar findings with less collateral circulation. At surgery, the anterior part of the Willis ring was found embedded in the suprasellar calcified granuloma. Recognition of cerebrovascular complication in tuberculous meningitis is important and an early modification of the therapy may improve the outcome.