Prognostic identifier of cerebrovascular complications in tuberculous meningitis: Meta-analysis

Abstract

IntroductionCerebrovascular complications could occur in 15–57 % of patients with tuberculous meningitis (TBM). It is crucial to rapidly identify TBM patients who are at risk for stroke. This study aimed to find predictors of stroke in patients with TBM. MethodsThis systematic review and meta-analysis were done using literature searches through online databases up to April 30th, 2022. Three independent authors performed literature screening, data extraction, and critical appraisal of the studies. Eight studies involving 1535 samples were included. ResultsWe analyzed data regarding demographic, comorbidity, clinical presentation, radiologic, and laboratory parameters. Overall, clinical presentation that showed outcome difference was found in patients with findings of vomiting (OR = 2.71, 95 % CI: 1.30–5.63), cranial nerve deficit (OR = 4.10, 95 % CI: 1.83–9.21), focal deficit (OR = 5.56, 95 % CI: 2.24–13.79), and altered consciousness (OR = 1.90, 95 % CI: 1.24–2.92). Some comorbidities showed significant differences such as diabetes mellitus (OR = 2.58, 95 % CI: 1.51–4.41), hypertension (OR = 5.73, 95 % CI: 3.36–9.77), ischemic heart disease (OR = 2.18, 95 % CI: 1.02–4.63), and smoking (OR = 2.65, 95 % CI: 1.22–5.77). Two radiological changes shown to have significantly higher proportions are hydrocephalus (OR = 2.50, 95 % CI: 1.74–3.58) and meningeal enhancements (OR = 3.99, 95 % CI: 1.73–9.20). ConclusionOur analysis indicated that clinical presentations of vomiting, cranial nerve deficit, focal deficit, altered consciousness; comorbidity of diabetes mellitus, hypertension, smoking history, ischemic heart disease; and radiological findings of meningeal enhancement and hydrocephalus showed significant association with stroke incidence in tuberculous meningitis.