After reading the interesting report of Alarco ´n et al. 1 on movement disorders (MD) and tuberculous meningitis (TBM), we would like to refer to the patients with dystonia in that series.
We had previously published an article describing three patients who developed cranial dystonia during the course of TBM. 2 Similarities and differences existed between these cases and those reported by Alarco ´n et al. 1 (one patient with cranial dystonia, one with dystonia of the right upper limb, and another with generalised dystonia). In our patients, imaging studies (computed tomography scan in one patient and magnetic resonance imaging in two patients) did not show any anatomic focal lesion, and blink reflexes and brainstem auditory-evoked potentials were abnormal, showing bilateral dysfunction of the motor nuclei of the facial nerve. 3,4 Four of the patients that have been reported in these two series (two of Alarco ´n et al. 1 and two of Serrano-Duen ˜as 2 ) had coexisting hydrocephalus (Table 1), which has been described in cases associated with cranial dystonia. 5,6 Jankovic 7 has proposed that this MD can be secondary to lesions that compromise the brainstem and the diencephalon. We believe that the role of hydrocephalus must be considered in the etiology of this MD when complicating the course of TBM, in addition to the possibility of bacterial toxins 8 and disorders of vascular perfusion, without resulting in stroke. 9