title: Hydrocephalus in tuberculous meningitis: Incidence, its predictive factors and impact on the prognosis.
abstract: BACKGROUND
  Hydrocephalus is one of the most common complications of tuberculous meningitis. The present study evaluated the incidence, predictive factors and impact of hydrocephalus on overall prognosis of tuberculous meningitis.
  
  
  METHODS
  In a prospective cohort study, all patients fulfilling the inclusion criteria of tuberculous meningitis underwent clinical and cerebrospinal fluid evaluation, together with magnetic resonance imaging of the brain. Patients were treated with antituberculosis drugs and dexamethasone. Follow up neuroimaging was done after 6 months. Hydrocephalus was assessed using Evan's index.
  
  
  RESULTS
  Of 80 patients with tuberculous meningitis, 52(65%) had hydrocephalus at presentation. During follow up, 8 new patients developed hydrocephalus. Factors associated with hydrocephalus included advanced stage of disease, severe disability, duration of illness > 2 months, diplopia, seizures, visual impairment, papilledema, cranial nerve palsy, hemiparesis, CSF total cell count > 100/cu.mm, CSF protein > 2.5 g/l. Neuroimaging factors that were significantly associated with hydrocephalus included basal exudates, tuberculoma and infarcts. Multivariate analysis revealed visual impairment, cranial nerve palsy and the presence of basal exudates as significant predictors of hydrocephalus. In 13 patients, with early tuberculous meningitis, there was complete resolution of hydrocephalus. Hydrocephalus was significantly associated with mortality and poor outcome.
  
  
  CONCLUSIONS
  Hydrocephalus occurs in approximately two-third of patients with tuberculous meningitis and has an unfavorable impact on the prognosis. Hydrocephalus in early stages of tuberculous meningitis may resolve completely.
authors.affiliation: Department of Neurology, King George Medical University, Uttar Pradesh, Lucknow 226003, India.
authors.forename: Tushar
authors.initials: T
authors.lastname: Raut
authors.forename: Ravindra Kumar
authors.initials: RK
authors.lastname: Garg
authors.forename: Amita
authors.initials: A
authors.lastname: Jain
authors.forename: Rajesh
authors.initials: R
authors.lastname: Verma
authors.forename: Maneesh Kumar
authors.initials: MK
authors.lastname: Singh
authors.forename: Hardeep Singh
authors.initials: HS
authors.lastname: Malhotra
authors.forename: Neera
authors.initials: N
authors.lastname: Kohli
authors.forename: Anit
authors.initials: A
authors.lastname: Parihar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D001921:Brain / Q000473:pathology; D015331:Cohort Studies; D003389:Cranial Nerve Diseases / Q000150:complications / Q000188:drug therapy / Q000473:pathology; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology*; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010211:Papilledema / Q000150:complications / Q000188:drug therapy / Q000473:pathology; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D014375:Tuberculoma / Q000150:complications / Q000188:drug therapy / Q000473:pathology; D014390:Tuberculosis, Meningeal / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D014786:Vision Disorders / Q000150:complications / Q000188:drug therapy / Q000473:pathology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents