Stage Of Tuberculous Meningitis Research Articles

Motor and somatosensory evoked potentials in tuberculous meningitis: a clinico-radiological correlation.

The sensory and motor functions in severe tuberculous meningitis (TBM) may be difficult to assess clinically and may be helped by evoked potential studies. Lack of motor and somatosensory evoked potential studies in TBM prompted the present study. All the patients with TBM underwent detailed neurological evaluation and cranial CT scan study. Motor and somatosensory evoked potentials to both upper and lower limbs were carried out bilaterally. The outcome was defined on the basis of 3 month Barthel Index (BI) score into good (BI > 12) and poor (BI < 12). Forty-one highly probable patients with TBM whose ages ranged between 8 and 64 years and 14 of whom were females were included in this study. Twenty-three patients were in stage III (meningitis, neurological signs and altered sensorium), 12 in stage II (meningitis with neurological sign) and the remaining patients were in stage I (meningitis only). Cranial CT scan was carried out in all and MRI in 18 patients. On CT scan hydrocephalus was present in 21, infarction in 14 and tuberculoma in 4 patients. Motor evoked potential (MEP) was abnormal in 18 patients (36 limbs) and SEP in 9 patients (23 limbs). Upper limb central motor conduction time to abductor digiti minimi (CMCT-ADM) was abnormal in 15 and that to tibialis anterior (TA) in 21 limbs. CMCT abnormality was lateralized in 6 and only upper or lower limbs were involved in 11 patients. The SEP abnormalities were lateralized in 2 patients and only upper or lower limbs were involved in 3. The MEP changes correlated with stage of TBM and outcome whereas SEP with outcome only. Motor and somatosensory evoked potentials may be helpful in objective documentation of respective motor and sensory functions in TBM patients with altered sensorium.

Prognosis of tuberculous meningitis: a multivariate analysis

Twenty-six clinical, laboratory and CT scan features in 49 patients with tuberculous meningitis (TBM) were analysed to identify the parameters of prognostic significance. Employing univariate analysis, seven variables were found to correlate with three month outcome; these variables included the stage of TBM on admission, focal weakness, Glasgow coma scale (GCS), incontinence, infarction, hydrocephalus and shunt surgery. Analysing all 26 variables, a conditional logistic regression model was derived. In this model stage of TBM, age, focal weakness, cranial nerve palsy and hydrocephalus were found to be contributing to the three month outcome of TBM patients as assesed by the Barthel index.

Serial lactate determinations in tuberculous meningitis.

Lactate levels in the cerebrospinal fluid (CSF) were determined in 21 patients with culture-proved tuberculous meningitis (TBM). All patients showed uniformly high lactate level (greater than or equal to 3.9 mmol/l). Neither the clinical stage of TBM nor the prognosis was related to the CSF lactate concentration. Repeated CSF studies demonstrated persistently high lactate levels in the early stage of illness despite adequate antituberculous therapy.

PRIMARY TUBERCULOUS MENINGITIS.WITH REPORT OF A CASE.

The case which I here report illustrates the extreme difficulty of making a diagnosis in the early stages of tuberculous meningitis. As stated editorially in a recent issue ofThe Journal, it is perfectly possible to have a primary tuberculous meningitis, synovitis, or osteomyelitis, with no other tuberculous lesion existing in any other part of the body, and it is in support of this statement that I report the following case. This child was sick two weeks before the symptoms were clear enough to make a positive diagnosis. Patient. —Alexander A., aged 3% years, had never been sick previously and was the picture of health. One paternal grandmother and one paternal uncle had died of tuberculosis. His parents were both living and healthy and being intelligent people had taken particular care in regard to his diet, exercise in the open air, etc., so that he was apparently as normal and