To investigate the clinical features, clinical diagnosis, treatment methods and maternal-infant prognosis of tuberculous meningitis in pregnancy.

Based on one case, who was admitted to Peking University Shenzhen Hospital, and 34 cases of intracranial tuberculosis were reported in the literature, we retrospectively reviewed the diagnosis, treatment and prognosis of pregnancy-related intracranial tuberculosis.

The 29-year-old patient was admitted to the Department of Neurology, Peking University Shenzhen Hospital on December 7, 2009 due to "pregnancy 25^{+ 2} week with repeated headaches with fever for 20 days and mental disorders for 2 days" . After admission, her symptoms further worsened. She was highly suspected of tuberculosis meningitis by meningitis irritation and imaging findings. Anti-tuberculosis treatment was initiated. Cenebrospinal fluid of the patient was mycobacterium tuberculosis positive. During the treatment, considering the teratogenic effects of streptomycin on the fetus, it was decided to use quadruple therapy including tetrabuterol and pyrazinamide, isoniazid, and rifampicin. Finally, the pregnant womant gave birth to a live baby by cesarean section at 32 weeks of gestation. Follow up the health of mother and baby after delivery. In the literatures from 1956 to 2020, 34 cases of intracranial tuberculosis in pregnancy and puerperium were reported. The clinical symptoms included 28 cases with headache (82.35%), 23 cases with fever (67.65%), and 16 cases with vomiting (47.06%), 15 cases with neck stiffness (44.12%), 6 cases with Kernig Yang sign (17.65%), 8 cases with convulsions (23.53%), 8 cases with hemiplegia (23.53%), 8 cases with drowsiness (23.53%), 8 cases with unconsciousness (23.53%), and 7 cases with optic nerve damage (20.59%). Among 33 cases with descriptions of maternal outcomes, 9 cases (27.27%) were cured after treatment. 17 cases (51.52%) were improved. 4 cases (12.12%) were died. 3 cases (9.09%) were left with visual impairment. The pregnant woman lost follow-up after treatment in the other case. There were 25 cases (73.53%) with described neonatal outcomes, of which 17 cases (68%) were healthy, 4 cases (16%) had congenital tuberculosis, and 4 cases (16%) died.

The clinical characteristics of tuberculous meningitis during pregnancy and puerperium mainly included fever, headache, nausea, vomiting, neck stiffness, and positive Kernig sign. Some cases may be accompanied by convulsions, and optic nerve damage. Coma appeared in severe cases. Anti-tuberculosis treatment is the main treatment plan. The prognosis of mothers and babies was related to the timing of starting anti-tuberculosis treatment. It is especially important to start anti-tuberculosis treatment as early as possible before the occurrence of coma.