Evaluation of 121 adult cases of tuberculous meningitis

OBJECTIVE: To evaluate serious complications of tuberculous meningitis (TBM), resulting from difficulties in diagnosis and treatment of the disease.

METHODS: Clinical and laboratory findings of 121 patients with TBM followed-up between the years 1998 and 2005 were evaluated retrospectively in Haseki Training and Research Hospital, Istanbul, Turkey. The patients were diagnosed by history, physical examination findings, CSF findings, CSF culture, and radiological imaging techniques, and were treated with isoniazid, rifampicin, ethambutol, pyrazinamide, and dexamethasone.

RESULTS: The age distribution of 121 patients was 15-70 (31+/-14.0 years). Most frequent complaint on admission was headache, and most frequent findings were nuchal rigidity, alteration in consciousness, and fever. Forty-four patients had active pulmonary tuberculosis, 33 had a history of pulmonary tuberculosis, 24 had a family member with active pulmonary tuberculosis, and one had HIV infection. Mycobacterium tuberculosis was isolated from CSF in 52 patients (43%). At cranial imaging, basal meningitis, tuberculoma, and hydrocephalus were the most common findings. Of 121 patients who were treated, 69 recovered completely, 40 recovered with neurological sequels, and 12 patients died. Ten of the deceased had stage III TBM.

CONCLUSION: Tuberculous meningitis is one of the most severe clinical forms of tuberculosis. Mortality is directly related with the stage of the disease.