title: Clinical relevance of hydrocephalus as a presenting feature of tuberculous meningitis.
abstract: BACKGROUND
  Hydrocephalus is a common complication of tuberculous meningitis (TBM).
  
  
  OBJECTIVE
  To study the incidence, associated clinical features, and impact on outcome of hydrocephalus at presentation in TBM.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  Regional hospital serving 500,000 people.
  
  
  METHODS
  Adult patients with TBM were studied over 57 months. Those with hydrocephalus on initial CT scan were assessed by neurosurgeons. Clinical, neuroradiological, and biochemical features of patients with hydrocephalus upon presentation were compared to those without initial hydrocephalus.
  
  
  RESULTS
  Of 31 TBM patients during the study period, nine (29.0%) had hydrocephalus at presentation, and eight of them (25.8% of all) underwent urgent neurosurgical intervention. Of the 22 patients without initial hydrocephalus, hydrocephalus developed after commencement of chemotherapy in one patient only. Hydrocephalus at presentation was associated with a longer duration of presenting symptoms (p = 0.01), ataxia (p = 0.001), later stages of TBM (p = 0.045), a longer delay before commencement of anti-tuberculous chemotherapy (p = 0.001), stroke (p = 0.012), and a poor outcome at 1 year (p = 0.001).
  
  
  CONCLUSIONS
  Hydrocephalus upon presentation is common in our TBM patients. This may be a poor prognostic marker associated with severe TBM and a higher risk of stroke.
authors.affiliation: Division of Neurology, University Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
authors.forename: K H
authors.initials: KH
authors.lastname: Chan
authors.forename: R T F
authors.initials: RT
authors.lastname: Cheung
authors.forename: C Y
authors.initials: CY
authors.lastname: Fong
authors.forename: K L
authors.initials: KL
authors.lastname: Tsang
authors.forename: W
authors.initials: W
authors.lastname: Mak
authors.forename: S L
authors.initials: SL
authors.lastname: Ho
mesh_terms: D000328:Adult; D000914:Antibodies, Viral / Q000032:analysis; D000995:Antitubercular Agents / Q000627:therapeutic use; D005260:Female; D006678:HIV / Q000276:immunology; D006801:Humans; D006849:Hydrocephalus / Q000134:cerebrospinal fluid / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D009422:Nervous System Diseases / Q000150:complications; D011379:Prognosis; D012307:Risk Factors; D020521:Stroke / Q000150:complications; D013997:Time Factors; D014390:Tuberculosis, Meningeal / Q000134:cerebrospinal fluid / Q000150:complications* / Q000188:drug therapy
chemical_list: D000914:Antibodies, Viral; D000995:Antitubercular Agents