title: Bladder dysfunction and urodynamic study in tuberculous meningitis.
abstract: BACKGROUND
  Micturitional disturbances in tuberculous meningitis have been reported infrequently and that too without urodynamic studies. Bladder dysfunction in tuberculous meningitis is often considered secondary to tuberculous radiculomyelopathy. We, in this study, evaluated the incidence and pattern of bladder dysfunction in tuberculous meningitis.
  
  
  METHODS
  In this prospective study, 51 patients were included. In addition to clinical evaluation, patients were subjected to a urodynamic study along with magnetic resonance imaging (MRI) of brain and spine. Patients were followed up for 6 months. A follow-up urodynamic study was performed after 6 months.
  
  
  RESULTS
  Out of 51 patients, urinary symptoms were present in one-third of the patients. Approximately, 70% (36) of the patients had urodynamic abnormalities. The commonest (22/51) urodynamic abnormality was detrusor hyporeflexia/areflexia. Other urodynamic abnormalities were neurogenic detrusor overactivity in 10, detrusor sphincter dyssynergia in 6, normal detrusor activity in 19, reduced bladder sensation in 12, raised cystometric capacity in 9, and larger volumes of post-void residual urine in 12 patients. Six patients were unable to void on command. Three patients with neurogenic detrusor overactivity had leak during study. MRI showed spinal meningeal enhancement in 37, lumbosacral arachnoiditis in 25, myelitis in 12 patients, CSF loculations in 6, and cord atrophy in 5 patients. Spinal arachnoiditis and urinary symptoms showed significant association with urodynamic abnormalities. Follow-up urodynamic study showed resolution of urodynamic abnormalities in 72.6% of the patients with treatment. Seven (28%) patients, with normal baseline urodynamic findings, paradoxically developed new abnormalities.
  
  
  CONCLUSIONS
  Bladder dysfunctions, in tuberculous meningitis, are frequently encountered. A significant association exists between urodynamic abnormalities and tuberculous lumbosacral arachnoiditis and myeloradiculopathy.
authors.affiliation: Department of Neurology, King George Medical University, Uttar Pradesh, Lucknow, India.
authors.forename: Arvind
authors.initials: A
authors.lastname: Gupta
authors.forename: Ravindra Kumar
authors.initials: RK
authors.lastname: Garg
authors.forename: Maneesh Kumar
authors.initials: MK
authors.lastname: Singh
authors.forename: Rajesh
authors.initials: R
authors.lastname: Verma
authors.forename: Hardeep Singh
authors.initials: HS
authors.lastname: Malhotra
authors.forename: Shiv Narayan
authors.initials: SN
authors.lastname: Sankhwar
authors.forename: Amita
authors.initials: A
authors.lastname: Jain
authors.forename: Ragini
authors.initials: R
authors.lastname: Singh
authors.forename: Anit
authors.initials: A
authors.lastname: Parihar
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011446:Prospective Studies; D014390:Tuberculosis, Meningeal / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D001743:Urinary Bladder / Q000503:physiopathology*; D001745:Urinary Bladder Diseases / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D055815:Young Adult