Tuberculous Hydrocephalus: Comparison of Different Treatments With Regard to Icp, Ventricular Size and Clinical Outcome

Schoeman, Johan; Donald, Peter R.; Zyl, L. Van; Keet, M. P.; Wait, J

doi:10.1111/j.1469-8749.1991.tb14899.x

Cited by 105 publications

(46 citation statements)

References 18 publications

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“…Studies have shown that clinical diagnosis of the presence and degree of raised ICP is unreliable, especially in children with closed anterior fontanels [16]. The value of CT imaging is limited by the poor correlation between the degree of hydrocephalus (ventricular size) and ICP [16]. Similarly, in this study, no correlation was found between ventricular size on CT and the degree of raised ICP (p=0.73).…”

Section: Discussioncontrasting

confidence: 63%

“…Inhibition of CSF flow occurs once 99.5 % of choroid plexus carbonic anhydrase is inhibited [21]. In children with communicating tuberculous hydrocephalus, acetazolamide and furosemide in combination have been found to be more effective in achieving normal ICP than antituberculous drugs alone [16]. In this study, rapid normalization of ICP occurred within 7 days of therapy in all 10 cases of communicating tuberculous hydrocephalus who had elevated ICP (Fig.…”

Section: Discussionmentioning

confidence: 71%

“…coma) and because it is treatable. Studies have shown that clinical diagnosis of the presence and degree of raised ICP is unreliable, especially in children with closed anterior fontanels [16]. The value of CT imaging is limited by the poor correlation between the degree of hydrocephalus (ventricular size) and ICP [16].…”

Section: Discussionmentioning

confidence: 99%

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The value of transcranial Doppler imaging in children with tuberculous meningitis

et al. 2014

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Purpose Transcranial Doppler imaging (TCDI) is potentially a valuable investigational tool in children with tuberculous meningitis (TBM), a condition often complicated by pathology relevant to Doppler imaging such as raised intracranial pressure (ICP) and cerebral vasculopathies. Methods Serial TCDI was performed on 20 TBM children with the aim of investigating cerebrovascular haemodynamics and the relationship between pulsatility index (PI) and ICP. Results We observed a poor correlation between ICP and PI in children with communicating hydrocephalus (p=0.72). No decline in PI was noted following 7 days of medical therapy for communicating hydrocephalus (p=0.78) despite a concomitant decline in ICP. Conversely, a decline in PI was noted in all four children with non-communicating hydrocephalus who underwent cerebrospinal fluid diversion. High blood flow velocities (BFV) in all the basal cerebral arteries were observed in 14 children (70 %). The high BFV persisted for 7 days suggesting stenosis due to vasculitis rather than functional vasospasm. Complete middle cerebral artery (MCA) occlusion, subnormal mean MCA velocities (<40 cm/s) and PIs (<0.4) correlated with radiologically proven large cerebral infarcts. Conclusions TCDI-derived PI is not a reliable indicator of raised ICP in children with tuberculous hydrocephalus. This may be attributed to individual variation of tuberculous vascular disease, possibly compromising cerebral vascular compliance and resistance. Basal artery stenosis secondary to vasculitis is observed during the acute stage of TBM in the majority of children.

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Section: Discussioncontrasting

confidence: 63%

Section: Discussionmentioning

confidence: 71%

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The value of transcranial Doppler imaging in children with tuberculous meningitis

et al. 2014

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“…The method that is most effective for treating TBM-associated hydrocephalus has not been specifically studied to date. For individuals with communicating hydrocephalus, the addition of acetazolamide and furosemide to standard antituberculosis therapy is superior to antibiotics alone (181). For those with noncommunicating hydrocephalus, some form of external drainage and/or VPS is needed.…”

Section: Surgical Therapymentioning

confidence: 99%

Central Nervous System Tuberculosis: Pathogenesis and Clinical Aspects

et al. 2008

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SUMMARY Tuberculosis of the central nervous system (CNS) is a highly devastating form of tuberculosis, which, even in the setting of appropriate antitubercular therapy, leads to unacceptable levels of morbidity and mortality. Despite the development of promising molecular diagnostic techniques, diagnosis of CNS tuberculosis relies largely on microbiological methods that are insensitive, and as such, CNS tuberculosis remains a formidable diagnostic challenge. Insights into the basic neuropathogenesis of Mycobacterium tuberculosis and the development of an appropriate animal model are desperately needed. The optimal regimen and length of treatment are largely unknown, and with the rising incidence of multidrug-resistant strains of M. tuberculosis, the development of well-tolerated and effective antibiotics remains a continued need. While the most widely used vaccine in the world largely targets this manifestation of tuberculosis, the BCG vaccine has not fulfilled the promise of eliminating CNS tuberculosis. We put forth this review to highlight the current understanding of the neuropathogenesis of M. tuberculosis, to discuss certain epidemiological, clinical, diagnostic, and therapeutic aspects of CNS tuberculosis, and also to underscore the many unmet needs in this important field.

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“…Distinction between the two is important in terms of potential treatment options. Communicating hydrocephalus is more common in TBM (82%) [107].…”

Section: Raised Intracranial Pressure and Hydrocephalusmentioning

confidence: 99%

Tuberculous Meningitis in Adults: A Review of a Decade of Developments Focusing on Prognostic Factors for Outcome

2012

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Tuberculous meningitis (TBM) is the most severe form of TB. Despite treatment, mortality and long-term disability remain unacceptably high. Prevention, early recognition, diagnosis and treatment are fundamental to improving outcomes. However, an effective vaccine remains elusive, initial symptoms are nonspecific, and sensitive diagnostic tests are not available. There has been progress in our understanding of the immunopathology of TBM, and several factors have been found to be associated with susceptibility to infection, disease progression and clinical outcome. However, these have not yet impacted on treatment. Early treatment initiation and uninterrupted continuation, severity on presentation, seizures, stroke, cranial nerve involvement, cerebrospinal fluid cell count and lactate levels, hyponatreamia and coinfection with HIV are all found to be important prognostic factors for outcome. Pathogen lineage (Beijing genotype) and host genetics (polymorphisms in TLR2, TIRAP and LTA4H genes) can influence susceptibility to TBM. However, these findings have not yet impacted on treatment. Progress in vaccine development, opportunities for better diagnostic tests, novel insights into pathogenesis and an increasing evidence base for improving treatment should impact the current high mortality and morbidity, if translated to global and local guidelines.

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Tuberculous Hydrocephalus: Comparison of Different Treatments With Regard to Icp, Ventricular Size and Clinical Outcome

Cited by 105 publications

References 18 publications

The value of transcranial Doppler imaging in children with tuberculous meningitis

The value of transcranial Doppler imaging in children with tuberculous meningitis

Central Nervous System Tuberculosis: Pathogenesis and Clinical Aspects

Tuberculous Meningitis in Adults: A Review of a Decade of Developments Focusing on Prognostic Factors for Outcome

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