Role of clinical, radiological, and neurophysiological changes in predicting the outcome of tuberculous meningitis: a multivariable analysis

Abstract

Objectives-The role of EEG and evoked potentials has not been evaluated in predicting the prognosis of tuberculous (TB) meningitis. The present study was aimed at evaluating the prognostic significance of clinical, radiological, and neurophysiological variables using multivariable analysis. Methods-Patients with TB meningitis diagnosed on the basis of clinical, radiological, and CSF criteria have been prospectively evaluated. All the patients were subjected to a detailed neurological evaluation. The outcome was defined 6 months after starting treatment on the basis of the Barthel index (BI) score into poor (BI <12) and good recovery (BI>12). Death was included in the poor recovery group for statistical analysis. Thirteen clinical (age, sex, seizure, focal weakness, stage of meningitis, Glasgow coma scale score, methyl prednisolone therapy), CT (infarction, hydrocephalus, tuberculoma) and neurophysiological (EEG, motor and somatosensory evoked potentials) variables were evaluated employing single variable logistic regression followed by multivariable logistic regression analysis. The best set of predictors were obtained by stepdown logistic regression analysis. Results-Fifty four patients were included in the present study. Their age ranged between 5 and 62 years, 11 were children younger than 12 years and 14 were female. Nine patients were in stage I meningitis, 12 in stage II, and 33 in stage III. On single variable logistic regression analysis the significant predictors of 6 months outcome of TB meningitis included focal weakness, Glasgow coma scale (GCS), motor evoked potential (MEP) and somatosensory evoked potential (SEP). On multivariable analysis the best set of predictors comprised focal weakness, GCS, and SEP. Conclusions-In patients with TB meningitis focal weakness, GCS, and SEP are the best predictors of 6 month outcome. (J Neurol Neurosurg Psychiatry 2000;68:300-303)

Results of a Multinational Study Suggest the Need for Rapid Diagnosis and Early Antiviral Treatment at the Onset of Herpetic Meningoencephalitis

“…On the other hand, the data in the literature related to the efficacy of treatment in HSV-2 meningitis are rather unclear (25,26).The host parameters directly affect the course of central nervous system (CNS) infections. In different types of CNS infections, increasing age and lower GCS scores have long been known to be associated with poor outcomes (27)(28)(29). Our HME data were also in accordance with those regarding other infectious CNS disorders and with the initial reports of adult HME series (10,18,19).…”

Seizure increases electroencephalographic abnormalities in children with tuberculous meningitis

“…The other factors contributing to altered sensorium in TBM may include hydrocephalus, infarction, or tuberculoma in a strategic location. (18) The overall prognosis of TBM remains poor, with 10-20% case fatality (worse if treatment is delayed and the patient is comatose) and 20-30% long term morbidity (cognitive and behavioral impairment, epilepsy, cranial nerve palsies and paresis). (19) Early diagnosis and treatment correlates with better outcomes.…”

Fulminant Tuberculous Meningitis

“…8) Poor out-come is associated with higher age, cranial nerve deficit, SIADH, abnormal electroencephalography, attenuation of motor evoked potentials, and low Glasgow Coma Scale score. Another important factor affecting the prognosis is the timing of initial treatment.…”