Outcomes of Tuberculous Meningitis Patients with Hydrocephalus with or without Cerebrospinal Fluid Diversion

Nabila Chantikarizky Hasanah, Akhmad Imron, Ahmad Rizal Ganiem

Abstract


Background: Hydrocephalus is a common complication in tuberculous meningitis patients and is a poor predictor with high mortality and morbidity rates. Therefore, early diagnosis, detection, and treatment of hydrocephalus are important. Cerebrospinal fluid diversion is the process used to drain accumulated fluid in the brain and spinal cord. This study aimed to explore the outcome of tuberculous meningitis patients with hydrocephalus who underwent cerebrospinal fluid diversion and who did not.

Methods: This was a retrospective cross-sectional descriptive study, including tuberculosis meningitis patients with hydrocephalus, admitted at the Department of Neurology Dr. Hasan Sadikin Bandung General Hospital during the period 2018. Functional outcomes were grouped based on the Glasgow Outcome Scale.

Results: Of the 55 patients, only 14 (25.5%) underwent cerebrospinal fluid diversion. The outcome of patients with cerebrospinal fluid diversion was 8 of 14 good, 1 of 14 poor, and 5 of 14 died. The outcome of patients without cerebrospinal fluid diversion was 13 of 41 good, 2 of 41 poor, and 26 of 41 died. Most tuberculous meningitis patients with hydrocephalus, with or without the cerebrospinal fluid diversion procedure were at an advanced stage with a high mortality rate.

Conclusion: The proportion of good functional outcomes in patients with cerebrospinal fluid diversion is higher than in patients without the cerebrospinal fluid diversion.

 


Keywords


Cerebrospinal fluid diversion, hydrocephalus, outcome, tuberculous meningitis

Full Text:

PDF

References


World Health Organization. Global tuberculosis report 2020. Geneva: World Health Organization; 2020.

Ramirez-Lapausa M, Menendez-Saldana A, Noguerado-Asensio A. Extrapulmonary tubercolosis:an overview. Rev Esp Sanid Penit. 2015;17:3–11.

Hsu PC, Yang CC, Ye JJ, Huang PY, Chiang PC, Lee MH. Prognostic factors of tuberculous meningitis in adults: a 6-year retrospective study at a tertiary hospital in northern Taiwan. J Microbiol Immunol Infect. 2010;43(2):111–8.

Raut T, Garg RK, Jain A, Verma R, Singh MK, Malhotra HS, et al. Hydrocephalus in tuberculous meningitis: incidence, its predictive factors and impact on the prognosis. J Infect. 2013;66(4):330–7.

Davis A, Meintjes G, Wilkinson RJ. Treatment of tuberculous meningitis and its complications in adults. Curr Treat Options Neurol. 2018;20(3):5.

Rizvi I, Garg RK, Malhotra HS, Kumar N, Sharma E, Srivastava C, et al. Ventriculo-peritoneal shunt surgery for tuberculous meningitis: A systematic review. J Neurol Sci. 2017;375:255–63.

Rajshekhar V. Management of hydrocephalus in patients with tuberculous meningitis. Neurol India. 2009;57(4):368–74.

Wilkinson RJ, Rohlwink U, Misra UK, Van Crevel R, Mai NTH, Dooley KE, et al. Tuberculous meningitis. Nat Rev Neurol. 2017;13(10):581–98.

Palur R, Rajshekhar V, Chandy MJ, Joseph T, Abraham J. Shunt surgery for hydrocephalus in tuberculous meningitis: A long-term follow-up study. J Neurosurg. 1991;74(1):64–9.

Budiman ATM, Suraya N, Faried A, Parwati I. Characteristics of cerebrospinal fluid in tuberculous meningitis patients with hydrocephalus. IJIHS. 2018;6(2):57–62.

Davis AG, Rohlwink UK, Proust A, Figaji AA, Wilkinson RJ. The pathogenesis of tuberculous meningitis. J Leukoc Biol. 2019;105(2):267–80.

Sharma P, Garg RK, Verma R, Singh MK, Shukla R. Incidence, predictors and prognostic value of cranial nerve involvement in patients with tuberculous meningitis: a retrospective evaluation. Eur J Intern Med. 2011;22(3):289–95.

Huang HJ, Ren ZZ, Dai YN, Tong YX, Yang DH, Chen MJ, et al. Old age and hydrocephalus are associated with poor prognosis in patients with tuberculous meningitis: a retrospective study in a Chinese adult population. Medicine (Baltimore). 2017;96(26):e7370.

Peng J, Deng X, He F, Omran A, Zhang C, Yin F, et al. Role of ventriculoperitoneal shunt surgery in grade IV tubercular meningitis with hydrocephalus. Childs Nerv Syst. 2012;28(2):209–15.

Kanesen D, Kandasamy R, Hieng AWS, Tharakan J, Lim CJ, Abdullah JM. Outcome of hydrocephalus in tuberculous meningitis. a retrospective study. Research Square [Preprints] 2020 [cited 2020 November 22]. Available from: https://www.researchsquare.com/article/rs-77026/v1.

Hassan M, Tuckman HP, Patrick RH, Kountz DS, Kohn JL. Hospital length of stay and probability of acquiring infection. IJPHM. 2010;4(4):324–38.

George AJ, Boehme AK, Siegler JE, Monlezun D, Fowler BD, Shaban A, et al. Hospital-acquired infection underlies poor functional outcome in patients with prolonged length of stay. ISRN Stroke. 2013;2013:312348.

Kemaloglu S, Özkan Ü, Bukte Y, Ceviz A, Özates M. Timing of shunt surgery in childhood tuberculous meningitis with hydrocephalus. Pediatr Neurosurg. 2002;37(4):194–8.




DOI: https://doi.org/10.15850/amj.v8n4.2300

Article Metrics

Abstract view : 650 times
PDF - 378 times



 This Journal indexed by

                  

          

 

Creative Commons License
AMJ is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

 


View My Stats