Abstract
PurposeTo study outcome of Hydrocephalus in Tuberculous Meningitis (TBMH) and factors associated with poor clinical outcome.MethodsClinical data of 143 adult patients diagnosed with TBM over a 6-year period in 2 tertiary hospitals in Malaysia were retrospectively reviewed. Relevant clinical and radiological data was studied. Patients with Hydrocephalus in TBM (TBMH) were further analysed based on their clinical grade and rendered treatment to identify prognostic factors and outcome of this subgroup of patients. The functional outcome of patients was assessed at 12 months from treatment.Results The mean age of patients was 35.6P12.4 year, with a male gender predominance of 67.1%. Forty four percent had TBMH, of which 42.9% had surgical intervention. In the good Modified Vellore Grade, 76.5% was managed medically with concurrent ATT, steroids and osmotic agents. Four patients had surgery early in the disease as they did not respond to medical therapy and reported a good outcome subsequently. Poor outcome (65.2%) was seen in the poor Modified Vellore Grade despite medical and surgical intervention. Multivariate model Multiple Cox Regression showed significant results for seizure (adjusted HR: 15.05, 95%CI: 3.73, 60.78), GCS (adjusted HR: 0.79, 95%CI: 0.70, 0.89) and CSF cell count (adjusted HR: 1.11, 95%CI: 1.05, 1.17).Conclusion Hydrocephalus was seen in 44% of patients in this study. GCS score, seizure and high CSF cell count were factors associated with a poor prognosis in TBM. Patients with TBMHM had better survival function compared to those with TBMHS (p value <0.001). This retrospective study emphasizes that TBMH is still a serious illness, as 47.6% of these patients had poor outcome despite adequate treatment.
Outcome of Hydrocephalus in Tuberculous Meningitis. A Retrospective Study
