Analysis and outcome of 30 patients with tuberculous meningitis

ABSTRACT

The study was conducted to see the presentation of tuberculous meningitis [TBM] and its associated complications in thirty patients. Place Medical departments of Holy Family Hospital, Rawalpindi General Hospital and District Headquarters Hospital, Rawalpindi Study Design: Descriptive Study Thirty patients were selected on non-probability convenient sampling from December 2000 to mid of July 2001. Patients who had history and clinical examination and investigations suggestive of TBM were included in the study. Result: Mostly, patients were young; the mean age was 29.67 years with the highest age specific incidence between 12--24 years age group. Being a chronic disease, the presentation to hospital was late with mean duration of illness 29.13 days. Majority presented with fever, headache, vomiting, neck stiffness and altered conscious level. Different complications were seen in the patients; hydrocephalus was seen in 60% and cranial nerve palsies in 50% cases. Fits were not seen in any of the patients in this study. Cerebrospinal fluid [CSF] and CT Scan were most helpful in diagnosis. There was lymphocytic pleocytosis, with low sugar and high proteins in 93.3% cases. CT scan showed basilar meningeal enhancement with or without ventricular dilatation in majority of the patients. However, positive smear AFB for CSF and sputum was low and seen in 6.6% cases. Pulmonary infiltrates on chest x-ray were seen in 33.3% and miliary pattern in 13.3% only. Regarding the outcome, 30% fully recovered, 46% made partial recovery while 23.3% died of TBM. Advanced stage at presentation and delayed treatment were associated with poor outcome in majority. TBM is a serious illness often with atypical clinical, biochemical and radiological features