Prognostic Value of Computed Tomography−Evident Cerebral Infarcts in Adult Patients with Tuberculous Meningitis and Hydrocephalus Treated with an External Ventricular Drain (original) (raw)
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Clinical Outcome of Tuberculous Meningitis with Hydrocephalus — A Retrospective Study
The Malaysian Journal of Medical Science, 2021
Background: To study the clinical outcome of tuberculous meningitis with hydrocephalus (TBMH) and the factors contributing to its poor clinical outcome. Methods: Clinical data of 143 adult patients diagnosed with TBM over a 6-year period in two tertiary hospitals in Malaysia were retrospectively reviewed. Relevant clinical and radiological data were studied. Patients with TBMH were further analysed based on their clinical grade and rendered treatment to identify associated factors and outcome of this subgroup of patients. The functional outcome of patients was assessed at 12 months from treatment. Results: The mean age of patients was 35.6 (12.4) years old, with a male gender predominance of 67.1%. Forty-four percent had TBMH, of which 42.9% had surgical intervention. In the good modified Vellore grade, 76.5% was managed medically with concurrent antituberculosis treatment (ATT), steroids and osmotic agents. Four patients had surgery early in the disease as they did not respond to medical therapy and reported a good outcome subsequently. Poor outcome (65.2%) was seen in the poor modified Vellore grade despite medical and surgical intervention. Multivariate model multiple Cox regression showed significant results for seizure (adjusted hazard ratio [aHR]: 15.05; 95% CI: 3.73, 60.78), Glasgow coma scale (GCS) (aHR: 0.79; 95% CI: 0.70, 0.89) and cerebrospinal fluid (CSF) cell count (aHR: 1.11; 95% CI: 1.05, 1.17). Conclusion: Hydrocephalus was seen in 44% of patients in this study. GCS score, seizure and high CSF cell count were factors associated with a poor prognosis in TBM. Patients with TBMH treated medically (TBMHM) had better survival function compared to TBMH patients undergoing surgical intervention (TBMHS) (P-value < 0.001). This retrospective study emphasises that TBMH is still a serious illness as 47.6% of the patients had poor outcome despite adequate treatment.
Outcome of Hydrocephalus in Tuberculous Meningitis. A Retrospective Study
2020
PurposeTo study outcome of Hydrocephalus in Tuberculous Meningitis (TBMH) and factors associated with poor clinical outcome.MethodsClinical data of 143 adult patients diagnosed with TBM over a 6-year period in 2 tertiary hospitals in Malaysia were retrospectively reviewed. Relevant clinical and radiological data was studied. Patients with Hydrocephalus in TBM (TBMH) were further analysed based on their clinical grade and rendered treatment to identify prognostic factors and outcome of this subgroup of patients. The functional outcome of patients was assessed at 12 months from treatment.Results The mean age of patients was 35.6P12.4 year, with a male gender predominance of 67.1%. Forty four percent had TBMH, of which 42.9% had surgical intervention. In the good Modified Vellore Grade, 76.5% was managed medically with concurrent ATT, steroids and osmotic agents. Four patients had surgery early in the disease as they did not respond to medical therapy and reported a good outcome subseq...
Role of endoscopic third ventriculostomy in tuberculous meningitis with hydrocephalus
Asian Journal of Neurosurgery, 2014
alternative to shunt procedures is an established treatment for obstructive hydrocephalus in TBM. [7,9-20] Role of ETV is controversial in communicating hydrocephalus and in acute phase of disease. The present article is aimed to review the role of ETV in TBM hydrocephalus. Indications of ETV in TBM hydrocephalus ETV is indicated in obstructive hydrocephalus in TBM. Most of the researchers prefer lumbar peritoneal shunt in communicating hydrocephalus, [21,22] although there are reports of ETV being performed in communicating hydrocephalus. [13,15] Endoscopic third ventriculostomy procedure ETV is technically difficult in post-infective hydrocephalus, especially in acute phase of disease due to presence of inflammation, thick and opaque floor of third ventricle. [7,10,17] It is comparatively simple in chronic phase of disease. There is an increased risk of hemorrhage and neurovascular injury, especially in acute phase. [10] Difficult cases in acute stage can be managed by water jet dissection. [10] Simple cases, in chronic phase, can be dealt by blunt perforation of the floor of third ventricle. Although ETV is technically possible in almost all cases of TBM hydrocephalus, proper case selection
Pediatric Infectious Disease Journal, 2016
Background-Pediatric tuberculous meningitis leads to high rates of mortality and morbidity. Prompt diagnosis and initiation of treatment are challenging; imaging findings play a key role in establishing the presumptive diagnosis. General brain imaging findings are well reported; however, specific data on cerebral vascular and spinal involvement in children are sparse. Methods-This prospective cohort study examined admission and follow up computed tomography brain scans and magnetic resonance imaging scans of the brain, cerebral vessels (magnetic resonance angiogram) and spine at 3 weeks in children treated for tuberculous meningitis with hydrocephalus (inclusion criteria). Exclusion criteria were no hydrocephalus on admission, treatment of hydrocephalus or commencement of anti-TB treatment before study enrolment. Imaging findings were examined in association with outcome at 6 months. Results-Forty-four patients (median age 3.3 [0.3-13.1] years) with definite (54%) or probable tuberculous meningitis were enrolled. Good clinical outcome was reported in 72%; the mortality rate was 16%. Infarcts were reported in 66% of patients and were predictive of poor outcome. Magnetic resonance angiogram abnormalities were reported in 55% of patients. Delayed tuberculomas developed in 11% of patients (after starting treatment). Spinal pathology was more common than expected, occurring in 76% of patients. Exudate in the spinal canal increased the difficulty of lumbar puncture and correlated with high cerebrospinal fluid protein content. Conclusion-Tuberculous meningitis involves extensive pathology in the central nervous system. Severe infarction was predictive of poor outcome although this was not the case for angiographic abnormalities.
Hydrocephalus Caused by Tuberculous Meningitis in an Immunocompetent Young Adult: A Case Report
International Medical Case Reports Journal
Background: Despite improved medical management, meningeal tuberculosis mortality and other outcomes have changed slightly over time due to a delay in diagnosis and treatment. This study reports a rare case of tuberculous meningitis in an immunocompetent host, calling into question the commonly held belief that tuberculous meningitis is a disease of immunocompromised individuals. Case Presentation: A 26-year-old male with no significant past medical history, tuberculosis, or indications of immunological compromise, was admitted to our hospital with a fever and altered mental status. He was drowsy, febrile (temperature of 38°C), had a heart rate of 110 beats per minute, and showed mild neck stiffness but no meningeal sign. A lumbar puncture on the third day of admission suggested tuberculous meningitis. He was treated for tuberculosis meningitis, and his condition slightly improved. However, the patient's condition suddenly worsened, and a repeat contrast computed tomography (CT) of the brain showed the development of ventriculomegaly and basilar enhancement. Insertion of an emergency ventriculoperitoneal shunt was performed; however, the patient died ten days after hospital admission. Conclusion: We report a fatal case of tuberculous meningitis in an immunocompetent patient. Healthcare practitioners must be trained to identify and diagnose tuberculous meningitis promptly. Early treatment of tuberculous meningitis based on clinical diagnosis and symptoms improves clinical outcomes.
Journal of Clinical Neuroscience, 2007
Cerebral infarction as a complication of tubercular (TB) meningitis is not uncommon, but an adequate comparison of patients with and without stroke has not been carried out. This study was performed to evaluate the clinical characteristics of cerebral infarction secondary to TB meningitis, and to investigate predictive factors for cerebral infarction in patients with TB meningitis. Patients with TB meningitis were recruited over a period of 56 months. They were divided into two groups, those with and those without stroke. Demographic features and clinical, laboratory, and neuroradiological findings were compared between the two groups. We classified strokes into subtypes using neuroimaging findings. Of the 38 patients who were diagnosed with TB meningitis, eight also experienced cerebral infarction. The percentage of cerebrospinal fluid leukocytes that were neutrophils was significantly higher in patients with stroke (68%) than in patients without stroke (31%; p = 0.0001). Upon initial CT imaging, meningeal enhancement was found in 11 patients, and of these patients, six experienced stroke. There were no significant differences between the groups with respect to other clinical and laboratory features, including demographic features, time between meningitis onset and treatment initiation, peripheral white blood cell count, and cerebrospinal fluid findings. Five of the eight patients who developed stroke had lacunar infarcts. One of the three patients with territorial nonlacunar infarction died due to herniation. When treating patients with TB meningitis, the possibility of cerebral infarction should be considered when patients develop focal neurological signs, meningeal enhancement on a CT scan, and sustained polymorphic cerebrospinal fluid pleocytosis.
Shunting in tuberculous meningitis: a neurosurgeon's nightmare
Child's Nervous System, 2008
Objective In a developing country like India, tuberculosis is very common in spite of a mass vaccination programme. Meningitis, progressive arteritis, adhesive arachnoiditis and tuberculomas represent the wide spectrum of this potentially lethal disease. Hydrocephalus occurs in about one third of the patients with central nervous system tuberculosis. Majority of patients have large fourth ventricles with adhesive obstructions in the basal cerebrospinal fluid (CSF) cisterns. Aggressive CSF diversion does not always alter the course of the disease. Endoscopic procedures are rarely, if ever, successful. Ventriculo-peritoneal shunting is fraught with complications like high rate of infection and shunt tube blockage. So there is clearly a need to explore methods of CSF diversion. Methods In our series of 32 patients, we present the indications, prognostic indicators and types of shunt with the clinical outcome of childhood tuberculous meningitis. Conclusions Even though the results are far from satisfactory, early shunting still remains the best option to prevent long-term neurological sequelae.
Journal of Bangladesh College of Physicians and Surgeons/Journal of Bangladesh College of Physicians & Surgeons, 2024
Background: Tuberculous meningitis (TBM) is caused by Mycobacterium tuberculosis (M. tuberculosis) and is the most common form of central nervous system (CNS) tuberculosis (TB).The prevalence of TB meningitis remains largely underestimated because clinical manifestations are nonspecific in early stages of the disease. Prompt diagnosis is critical for initiating appropriate therapy, facilitating measures to prevent dissemination of this highly contagious disease and to combat fatal complication in children Aims: To evaluate the role of neuroimaging changes and treatment outcome of tubercular meningitis. Methods: This prospective hospital-based cohort study was conducted in Department of Paediatric Neurology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, during January 2022 to December 2022. Children age belonged to 1 month to 10 year diagnosed as TBM during study period were enrolled in this study. Detailed history, clinical examination, CSF analysis and other relevant investigations were done. Data were recorded in standard questionnaire. Statistical analyses of the results were obtained by using windowbased computer software devised with Statistical Packages for Social Sciences (SPSS-22). Results: Total 22 diagnosed case of TBM was enrolled and evaluated. Among them two third (63.63%) children were in 5-10 year age group. Male (59%) were outnumbered than female (36.36 %).Male female ratio was 1.6:1. More than half (59%) of patients came from urban area. All of the patients were vaccinated. Cent percent (100%) patients were presented with fever followed by headache (77.27%), sign of meningeal irritation (54.54%), vomiting (54.54%) and seizures (50%). Most common complication was hemiparesis (45.45%) followed by cranial nerve palsy (40.90%), visual problem (9.09%) and hydrocephalus (4.54%). Abnormal neuroimaging changes were found in 100% cases. Common findings were hydrocephalus (40.90%), tubercloma (36.36%), basilar enhancement (18.18%), Benign enlargement of subdural space & cerebellar hyperintensity (9%) and thalamic infract was present in 4.54% cases. Anti TB and steroid treatment were given in 100% cases and among them18.18% cases were required shunt procedure. More than one-third cases (40.90%) were completely normal without any no sequelae. Among abnormal sequelae found in two third (59%) cases. Speech impairment (36.36%) was most common followed by GDD (18.18%), hemiparesis (13.63%), quadriparesis (9.09%) and epilepsy in 9.09% cases. Conclusion: In our study all children of TBM were presented with fever followed by other predominant clinical features headache, vomiting, seizures and sign of meningeal irritation. Abnormal neuroimaging changes were found in all cases. Common findings were basilar enhancement, hydrocephalus, tubercloma, benign enlargement of subdural space & cerebellar hyper intensity and thalamic infract. After treatment more than one-third cases were completely normal without any no sequelae.