Acute Hemichorea-Hemiballismus in Patients with Tuberculous Meningitis: An Atypical Manifestation of Stroke

We report two cases of tuberculosis meningitis patients developing hemichorea-hemiballismus during antituberculosis treatment. First, a 56-year-old woman experienced right-sided hemichorea-hemiballismus 3 months into treatment. MRI scans revealed a left thalamus and subthalamic infarct. After 10 days of continued treatment and corticosteroids, her movements subsided. Second, a 17-year-old female developed hemichorea-hemiballismus while on antituberculosis drugs and corticosteroids. MRI scans displayed ischemic lesions, optochiasmatic arachnoiditis, gyral enhancement, and a small tuberculoma. After shunt surgery and tetrabenazine treatment, she significantly improved and resumed daily activities. In conclusion, hemichorea-hemiballismus may paradoxically occur in tuberculosis meningitis patients, potentially linked to ischemic lesions in the thalamus and subthalamus.