Hydrocephalus in tuberculous meningitis: incidence, its predictive factors and impact on the prognosis.
J Infect. 2013 Jan 2;
Authors: Raut T, Garg RK, Jain A, Verma R, Singh MK, Malhotra HS, Kohli N, Parihar A
Abstract
BACKGROUND: Hydrocephalus is one of the most common complications of tuberculous meningitis. The present study evaluated the incidence, predictive factors and impact of hydrocephalus on overall prognosis of tuberculous meningitis. MATERIAL AND METHODS: This was a prospective cohort study. Eighty patients, fulfilling the inclusion criteria of tuberculous meningitis, were included. In addition to clinical and cerebrospinal fluid evaluation, patients were subjected to magnetic resonance imaging of brain. Patients were treated with antituberculosis drugs and dexamethasone. Follow up neuroimaging was done after 6 months. Hydrocephalus was diagnosed with the help of Evan's index. Univariate and multivariate analyses were done to determine factors that were associated with hydrocephalus. RESULTS: This study included 80 patients. At inclusion, 52(65%) patients had hydrocephalus. During course of follow up, 8 new patients developed hydrocephalus. On univariate analysis factors, significantly associated with hydrocephalus, were advanced stage of disease, severe disability, duration of illness > 2 months, diplopia, seizures, visual impairment, papilledema, cranial nerve palsy, hemiparesis, total CSF cell count >100/cu.mm, CSF protein >2.5g/l. Neuroimaging factors that were significantly associated with hydrocephalus included basal exudates, tuberculoma and infarcts. Multivariate analysis revealed visual impairment, cranial nerve palsy and presence of basal exudates as significant predictors of hydrocephalus. In 13 patients, with early tuberculous meningitis, there was complete resolution of hydrocephalus. Hydrocephalus was significantly associated with mortality and poor outcome. CONCLUSION: Hydrocephalus occurs in approximately two-third of patients with tuberculous meningitis and has an unfavorable impact on the prognosis. Hydrocephalus in early stages of tuberculous meningitis may resolve completely.
PMID: 23291048 [PubMed - as supplied by publisher]