Shunt surgery in poor grade patients with tuberculous meningitis and hydrocephalus: effects of response to external ventricular drainage and other variables on long term outcome

✓ Hydrocephalus is a common complication of tuberculous meningitis. Case studies of 114 patients with tuberculous meningitis and hydrocephalus, who underwent shunt surgery between July, 1975, and June, 1986, were reviewed to evaluate the long-term outcome and to outline a management protocol for these patients based on the results. Seven factors were studied in each case: 1) age at admission; 2) grade on admission (I to IV, classified by the authors: Grade I being the best and Grade IV being the worst); 3) duration of alteration of sensorium; 4) cerebrospinal fluid (CSF) cell content at initial examination; 5) CSF protein levels at initial examination; 6) number of shunt revisions required; and 7) the necessity for bilateral shunts. During a long-term follow-up period ranging from 6 months to 13 years (mean 45.6 months), the mortality rate was 20% for patients in Grade I; 34.7% for patients in Grade II; 51.9% for patients in Grade III; and 100% for patients in Grade IV. Only the grade at the time of admission was found to be statistically significant in determining final outcome (p < 0.001). Based on these results, the authors advocate early shunt surgery for Grade I and II patients. For patients in Grade III, surgery may be performed either if external ventricular drainage causes an improvement in sensorium or without selection. All patients in Grade IV should undergo external ventricular drainage and only those who show a significant change in their neurological status within 24 to 48 hours of drainage, should have shunt surgery.

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Pupillary Reactivity Upon Hospital Admission Predicts Long-term Outcome in Poor Grade Aneurysmal Subarachnoid Hemorrhage Patients

Neurocritical Care ◽

10.1007/s12028-007-9031-1 ◽

2007 ◽

Vol 8 (3) ◽

pp. 374-379 ◽

Cited By ~ 15

Author(s):

William J. Mack ◽

Zachary L. Hickman ◽

Andrew F. Ducruet ◽

James T. Kalyvas ◽

Matthew C. Garrett ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Hospital Admission ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Term Outcome ◽

Long Term Outcome ◽

Poor Grade ◽

Pupillary Reactivity

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Long-term Outcome in Tuberculous Meningitis

The Lancet ◽

10.1016/s0140-6736(58)90385-4 ◽

1958 ◽

Vol 272 (7051) ◽

pp. 837

Keyword(s):

Tuberculous Meningitis ◽

Term Outcome ◽

Long Term Outcome

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Dexamethasone and Long-Term Outcome of Tuberculous Meningitis in Vietnamese Adults and Adolescents

PLoS ONE ◽

10.1371/journal.pone.0027821 ◽

2011 ◽

Vol 6 (12) ◽

pp. e27821 ◽

Cited By ~ 51

Author(s):

M. Estée Török ◽

Nguyen Duc Bang ◽

Tran Thi Hong Chau ◽

Nguyen Thi Bich Yen ◽

Guy E. Thwaites ◽

...

Keyword(s):

Tuberculous Meningitis ◽

Term Outcome ◽

Long Term Outcome

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Evaluation of a revised Glasgow Coma Score scale in predicting long-term outcome of poor grade aneurysmal subarachnoid hemorrhage patients

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2008.10.010 ◽

2009 ◽

Vol 16 (7) ◽

pp. 894-899 ◽

Cited By ~ 19

Author(s):

Robert M. Starke ◽

Ricardo J. Komotar ◽

Grace H. Kim ◽

Christopher P. Kellner ◽

Marc L. Otten ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Glasgow Coma Score ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Term Outcome ◽

Long Term Outcome ◽

Poor Grade

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Faculty Opinions recommendation of Dexamethasone and long-term outcome of tuberculous meningitis in Vietnamese adults and adolescents.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.13595957.15008056 ◽

2012 ◽

Author(s):

Diederik van de Beek ◽

Matthijs Brouwer

Keyword(s):

Tuberculous Meningitis ◽

Term Outcome ◽

Long Term Outcome

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Neurocognitive and functional impairment in adult and paediatric tuberculous meningitis

Wellcome Open Research ◽

10.12688/wellcomeopenres.15516.1 ◽

2019 ◽

Vol 4 ◽

pp. 178 ◽

Cited By ~ 3

Author(s):

Angharad G. Davis ◽

Sam Nightingale ◽

Priscilla E. Springer ◽

Regan Solomons ◽

Ana Arenivas ◽

...

Keyword(s):

Functional Impairment ◽

Tuberculous Meningitis ◽

Observational Studies ◽

Severe Illness ◽

Socioeconomic Level ◽

Term Outcome ◽

Long Term Outcome ◽

Cognitive Delay ◽

Neurological Infections

In those who survive tuberculous meningitis (TBM), the long-term outcome is uncertain; individuals may suffer neurocognitive, functional and psychiatric impairment, which may significantly affect their ability to lead their lives as they did prior to their diagnosis of TBM. In children who survive, severe illness has occurred at a crucial timepoint in their development, which can lead to behavioural and cognitive delay. The extent and nature of this impairment is poorly understood, particularly in adults. This is in part due to a lack of observational studies in this area but also inconsistent inclusion of outcome measures which can quantify these deficits in clinical studies. This leads to a paucity of appropriate rehabilitative therapies available for these individuals and their caregivers, as well as burden at a socioeconomic level. In this review, we discuss what is known about neurocognitive impairment in TBM, draw on lessons learnt from other neurological infections and discuss currently available and emerging tools to evaluate function and cognition and their value in TBM. We make recommendations on which measures should be used at what timepoints to assess for impairment, with a view to optimising and standardising assessment of neurocognitive and functional impairment in TBM research.

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LONG-TERM OUTCOME IN PATIENTS WITH SUSPECTED NORMAL PRESSURE HYDROCEPHALUS

Neurosurgery ◽

10.1227/01.neu.0000249273.41569.6e ◽

2007 ◽

Vol 60 (2) ◽

pp. 327-332 ◽

Cited By ~ 56

Author(s):

Babar Kahlon ◽

Johan Sjunnesson ◽

Stig Rehncrona

Keyword(s):

Cerebrospinal Fluid ◽

Reaction Time ◽

Normal Pressure Hydrocephalus ◽

Barthel Index ◽

Normal Pressure ◽

Shunt Surgery ◽

Term Outcome ◽

Long Term Outcome

Abstract OBJECTIVE To evaluate the outcome of patients with suspected normal pressure hydrocephalus at 6 months and 5 years after shunt surgery. METHODS Seventy-five patients (mean age, 72.5 6 9 yr), with normal pressure hydrocephalus symptoms were included. Fifty-four patients with positive lumbar infusion and/or cerebrospinal fluid tap tests received a cerebrospinal fluid shunt, whereas 21 patients with negative test results did not undergo operation. Walk, reaction time, memory, and identical forms tests were used as baseline (before surgery) tests and were repeated at short- (6.1 6 4.6 mo) and long-term (5.5 6 1.4 yr) follow-up evaluations. Activities of daily life functions were assessed using the Barthel index. RESULTS At the 6-month follow-up examination, 83% of the operated patients improved in gait, 65% improved in reaction time, 46% improved in memory, and 31% improved in identical forms tests; 96% found themselves subjectively improved. Because of unrelated mortality (37%) and declining general health from comorbidity, only 27 patients were available for the 5-year follow-up evaluation. Twenty-three of these patients had been treated with a shunt and had a remaining improvement in close to 40% in gait and reaction time, whereas fewer than 10% had an improvement in cognitive tests. Fifty-six percent reported subjective improvement compared with preoperative findings. More patients (64%) improved if younger than 75 years; for patients older than 75 years, only 11% of the patients improved. The Barthel index was higher (P < 0.05) in improved patients. CONCLUSION Patients with normal pressure hydrocephalus benefit from shunt surgery for at least 5 years. High mortality rate, comorbidity, and old age hamper good long-term outcome and emphasize the importance of patient selection.

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