ABSTRACT
Digital subtraction angiography (DSA) was performed in 24 adults with tuberculous meningitis (TBM) and results were correlated with 24 admission and 16 follow-up CT examinations. 19 MRI studies and clinical outcome at a mean follow-up of 44 weeks. DSA was abnormal in 11 patients. Abnormal DSA was associated with advanced clinical stages of the Medical Research Council classification, admission CT with hydrocephalus or gyral cortical enhancement. MRI disclosed brain infarcts not seen on initial CT in 8 cases. Of seven patients who died, 4 had abnormal and 3 normal DSA. Among patients who survived, those with normal DSA had a better functional outcome by Karnofsky scores. During follow-up infarcts were evident in 16 patients. Abnormal DSA in relation to brain infarcts had a sensitivity of 0.56, specificity 0.75, positive predictive value 0.82 and negative predictive value 0.46. A single arteriogram does not predict the outcome in patients with TBM and its value is limited in the assessment of vascular complications of TBM. Angiography in TBM is justified only in specific clinical trials to assess new therapeutic modalities against infarcts.
Subject(s)
Angiography, Digital Subtraction , Tuberculosis, Meningeal/diagnostic imaging , Adolescent , Adult , Aged , Cerebral Infarction/diagnostic imaging , Female , Humans , Male , Middle Aged , Neurologic Examination , Prognosis , Prospective Studies , Survival Rate , Tomography, X-Ray Computed , Tuberculosis, Meningeal/mortalityABSTRACT
In 2784 specimens submitted to the Clinical Microbiology Laboratory of the Instituto Nacional de Neurología from May 1989 to January 1990, 140 (5.0%) had gram negative bacilli (GNB) resistant to five or more antibiotics. One hundred different isolates recovered from urine, tracheal aspirates, blood, cerebrospinal fluid, surgical wound infections and other sites were studied. Pseudomonas spp, Enterobacter spp, Klebsiella pneumoniae and Escherichia coli accounted for 86% of the total. Disk diffusion susceptibility tests with the NCCLS method revealed 59 to 67% of isolates susceptible to amikacin, ciprofloxacin and ceftazidime. Sixteen to 30% were inhibited by piperacillin, cefoperazone and cefotaxime. Less than 10% were susceptible to carbenicillin, tobramycin, gentamicin, cephalothin and ampicillin. Minimum inhibitory concentrations (MIC) to amikacin and ciprofloxacin were determined by broth macrotube dilution in Mueller-Hinton broth supplemented with Ca and Mg ions with a 5 x 10(5) cfu/mL inocula. MIC of 16 ug/mL or less for amikacin was found in 39% of the isolates; MIC 50 was 32 ug/mL and MIC 90 greater than 64 ug/mL. Ciprofloxacin had MIC 50 of 1 ug/mL and an MIC 90 greater than 4 ug/mL. Higher MICs to ciprofloxacin were seen in Pseudomonas spp.
