Serial CT Scanning in Childhood Tuberculous Meningitis: Prognostic Features in 198 Cases

Abstract

Serial cranial computed tomographic (CT) scanning and intracranial pressure monitoring were performed on 198 children with stage II and III tuberculous meningitis. The aims of the study were to document the course of tuberculous hydrocephalus during medical and surgical treatment, as well as the prognostic significance of parenchymal changes in the brain as demonstrated by CT. Lumbar cerebrospinal fluid pressure was monitored continuously for a 1-hour period in all patients on admission and at weekly intervals in patients with communicating hydrocephalus for the 1st month of treatment. Cranial CT scanning was done on admission and repeated in survivors after 1 month and again after 6 months of antituberculous therapy. The raised intracranial pressure of 112 children with communicating hydrocephalus, as demonstrated by air-encephalography, was treated medically (with daily acetazolamide and furosemide) for 1 month. Thirty-one children with noncommunicating hydrocephalus were referred for immediate ventriculoperitoneal shunting. No significant difference was found in the eventual ventricular size or clinical outcome between the two treatment groups. Lumbar cerebrospinal fluid pressure changes in the children with communicating hydrocephalus closely followed changes in the degree of hydrocephalus during the course of treatment. The main cause of permanent neurologic disability was basal ganglia infarction, which occurred unilaterally in 21% and bilaterally in 10% of patients on admission and developed in a further 22% of children during treatment. A prominent subarachnoid space, which was seen on the CT scan of 36% of patients after the 1st month of treatment and which reverted to normal, probably relates to the poor nutritional state of these patients on admission.(ABSTRACT TRUNCATED AT 250 WORDS)

Massive Posterior Fossa Tuberculous Abscess Developing in a Young Child Treated for Miliary Tuberculosis

“…In a recent longitudinal study on CT scanning in childhood TBM, evidence was found of an ongoing inflammatory process [15]. Increasing basal enhancement (28% of patients) and new infarcts, probably due to progressive vasculitis (22% of patients), were evident on the CT scan after the 1st month of treatment.…”

A Study of CT Findings in children with neurotuberculosis

“…14,15,16 CT helps in recognising features suggestive of CNS tuberculosis like basal enhancement, tuberculoma and identifying complications of TBM including infarction and hydrocephalus. 8,17,18,19 The common triad of CT findings in TBM are:…”

“…6 As delay in diagnosis and treatment leads to greater morbidity and mortality, the emphasis should be on early diagnosis of neurotuberculosis. 7,8 The role of CT in early diagnosis of TBM and its complications is well established. 8,9,10 It is valuable in identifying intracranial lesions which are characteristic of neurotuberculosis.…”

“…7,8 The role of CT in early diagnosis of TBM and its complications is well established. 8,9,10 It is valuable in identifying intracranial lesions which are characteristic of neurotuberculosis. Cranial CT scan within 1 week of initial symptoms may reveal basilar enhancement or infarction.…”

HHH Regime for Arteritis Secondary to TB Meningitis: A Prospective Randomized Study

“…Cerebral infarctions are reported in up to one-third or more of patients with TBM, resulting in deficits such as hemoparesis, monoparesis, aphasia, cognitive impairment, visual field deficits, movement disorders, ataxia, brain stem syndromes, etc. [1,2]. In a CT study of 198 patients with TBM, basal ganglia infarcts were present at admission in 31% [1].…”