HHH regime for arteritis secondary to TB meningitis: a prospective randomized study.
BACKGROUND
Tuberculous meningitis (TBM) is a fairly common, debilitating disease and is often complicated by arteritis resulting in brain infarction. Few treatment regimes specifically address this condition. Hypervolemia-hypertension-hemodilution (HHH) regime is known to be effective for treatment of vasospasm complicating subarachnoid hemorrhage. We studied the efficacy of HHH regime in patients with TBM with arteritis using a prospective, randomized study design.


METHODS
Patients diagnosed to have TB meningitis by clinical, CSF, and imaging findings were evaluated for arteritis, which was recognized by presence of focal neurologic deficits with or without corresponding focal hypodensities on brain CT scan. Patients with deficits of < 96 h were randomized to HHH or conservative treatment. All patents received four-first-line anti-TB drugs and Inj.dexamethasone. HHH therapy was administered over 3-9 days. Neurologic status and modified Rankin score were noted serially and at discharge.


RESULTS
Seven patients received HHH and 5, conservative treatment. All had hemiparesis with power 0-3/5. Median GCS was worse in HHH group (11 vs. 13). In the HHH group, 6/7 improved in motor power, and 5/7 in sensorium. In the control group, 3/5 improved in motor power and 3/5 in sensorium. Four patients died in each group.


CONCLUSIONS
HHH therapy is safe and may be beneficial in the management of patients with infective arteritis secondary to TBM. Further study in a larger group with improved monitoring of cerebral circulation is indicated.
Gujjar
Arunodaya R
AR
Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India. grarunoday@hotmail.com.
Srikanth
S G
SG
Umamaheshwara Rao
G S
GS
D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D003422:Critical Care / Q000379:methods*; D005440:Fluid Therapy; D006438:Hemodilution; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D014390:Tuberculosis, Meningeal / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D020293:Vasculitis, Central Nervous System / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*; D055815:Young Adult
D000995:Antitubercular Agents; D014662:Vasoconstrictor Agents