Abstract
BackgroundNeurological complications of tuberculous meningitis (TBM) often lead to raised intracranial pressure (ICP) resulting in high morbidity and mortality. Measurement of optic nerve sheath diameter (ONSD) by point-of-care ultrasound may aid in the identification of raised ICP in TBM.MethodsFrom June 2017 to December 2019, 107 Vietnamese adults with TBM, enrolled in the ACT HIV or LAST ACT trials (NCT03092817, NCT03100786), underwent ONSD ultrasound at ≥1 of days 0, 3, 7, 14, 21, and day ±30 after enrollment. Demographic data, TBM severity grade, HIV coinfection status, and clinical endpoints by 3 months were recorded. ONSD values were correlated with disease severity, baseline brain imaging, cerebrospinal fluid parameters, and clinical endpoints.Results267 ONSD ultrasound scans were performed in 107 participants over the first 30 days of treatment, with measurements from 0.38–0.74 cm. Paired baseline ONSD and brain imaging were performed in 63 participants. Higher baseline ONSD was associated with more severe disease and abnormal brain imaging (abnormal imaging 0.55 cm vs 0.50 cm normal imaging, P = .01). Baseline median ONSD was significantly higher in participants who died by 3 months (0.56 cm [15/72]) versus participants who survived by 3 months (0.52 cm [57/72]) (P = .02). Median ONSD was higher at all follow-up times in participants who died by 3 months.ConclusionsHigher ONSD was associated with increased disease severity, brain imaging abnormalities, and increased death by 3 months. ONSD ultrasound has a potential role as a noninvasive, affordable bedside tool for predicting brain pathology and death in TBM.
Highlights
Neurological complications of tuberculous meningitis (TBM) often lead to raised intracranial pressure (ICP) resulting in high morbidity and mortality
optic nerve sheath diameter (ONSD) values were correlated with disease sc severity, baseline brain magnetic resonance imaging or computed tomography imaging, u cerebrospinal fluid parameters and clinical endpoints. n Results: 267 ONSD ultrasound scans were performed in 107 participants over the first 30 days of a treatment, with measurements from 0.38-0.74cm
Larger studies are required to further M investigate the role of ONSD ultrasound in TBM. d We sought to answer the following questions: does elevated ONSD correlate with HIV status, TBM te severity grade, or clinical endpoints by 3 months? Does elevated ONSD correlate with TBM brain p imaging abnormalities or features of raised ICP? Can an ONSD cut-off value predict TBM brain e imaging abnormalities or features of raised ICP? And how do ONSD values change during the first 30 c days of anti-TB chemotherapy? Ac Methods
Summary
Tuberculous meningitis (TBM) accounts for 2-5% of all TB cases. Death results in up to 50% of those with TBM,[1,2,3,4] largely due to severe neurological complications which are hard to predict and difficult to manage. Hydrocephalus, brain infarcts, and enlarging tuberculomas all contribute to the devastating morbidity and poor outcomes of TBM These complications may cause raised intracranial pressure (ICP), which can quickly lead to coma and death. Use of minimally- or non-invasive a methods for raised ICP detection is common in brain infection (table 1). Does elevated ONSD correlate with TBM brain p imaging abnormalities or features of raised ICP? Can an ONSD cut-off value predict TBM brain e imaging abnormalities or features of raised ICP? Larger studies are required to further M investigate the role of ONSD ultrasound in TBM. d We sought to answer the following questions: does elevated ONSD correlate with HIV status, TBM te severity grade, or clinical endpoints by 3 months? Does elevated ONSD correlate with TBM brain p imaging abnormalities or features of raised ICP? Can an ONSD cut-off value predict TBM brain e imaging abnormalities or features of raised ICP? And how do ONSD values change during the first 30 c days of anti-TB chemotherapy? Ac Methods
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