The risk factors affecting the outcome in 50 children with tuberculous meningitis were evaluated over a period of 20 months. Five children (10 per cent) had stage 1 disease, 29 (58 per cent) had stage II disease, and 16 (32 per cent) had stage III disease at admission. Seventeen cases (34 per cent) showed complete recovery, five (10 per cent) had mild, 14 (28 per cent) had moderate, and nine (18 per cent) had severe neurological sequelae. Five children (10 per cent) died. Younger age, tonic posturing, papilloedema, focal neurological deficit and stage at presentation were found to affect adversely the prognosis independently in children with tuberculous meningitis.
In select population with indicative clinical features, Keith Edwards score can be a definitive guideline for the diagnosis of childhood tuberculosis. However, more studies are required for the validation of this clinical score before it can be used as a definitive diagnostic reference standard for tuberculosis.
Awareness of the existence of disappearing SREL lesions is essential to avoid unnecessary treatment with antituberculous or anticysticercal therapy and provides ample justification in treating with anticonvulsant drugs only.
Tuberculin positivity is low in TBM irrespective of the nutritional status. At least some degree of inflammatory reaction can be seen at the site of tuberculin administration. In tuberculin negative cases, varying grades of cellular response in the absence of clinical induration can be seen in histopathology.
In the long term prediction of outcome in acute non-traumatic coma, MGCS is not useful. However, verbal response, a component of MGCS, correlates well with long term functional outcome and intelligence quotient.
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