title: Risk assessment of the outcome for cerebral infarction in tuberculous meningitis.
abstract: BACKGROUND
  Cerebral infarction in tuberculous meningitis is a major risk factor for permanent disability. This study assessed the clinical presentation of tuberculous meningitis and risks factors for cerebral infarction.
  
  
  METHODS
  Thirty-eight adult patients with tuberculous meningitis were studied between 2002 and 2006. Clinical, radiological, and laboratory data of patients with cerebral infarction were compared with those of patients without cerebral infarction. Patients with cerebral infarction were significantly older (65.1 vs 52.1years), had higher risk assessment scores (3.7 vs 2.2), and more often had basal meningeal enhancement on imaging (92.3% vs 60.0%), mild to moderate sequelae (69.2% vs 4%), an overall poor brain outcome (69.2% vs 8%), aspirin prescription (84% vs 8%), and neurosurgical intervention for hydrocephalus (54.0% vs 16.0%). Cerebral infarction patients were also more likely to have experienced doctor-related delays in antituberculosis (61.5% vs 36%) and corticosteroid (61.5% vs 32%) therapy.
  
  
  CONCLUSIONS
  The Framingham risk score would be an option for tuberculous meningitis patients to access cerebral infarction risk. Contrast-enhanced brain imaging is helpful for exploring basal meningeal enhancement, in order to obtain an early diagnosis. Antituberculosis, corticosteroid, and aspirin therapies should be started immediately when tuberculous meningitis is suspected.
authors.affiliation: Division of infectious disease, department of internal medicine, Changhua-Christian hospital, 135, Nanhsiau street, Changhua, Taiwan, Republic of China; Department of Nursing, College of Medicine & Nursing, Hung Kuang University, Taichung, Republic of China. Electronic address: chenchanghuachad@gmail.com.
authors.forename: C-H
authors.initials: CH
authors.lastname: Chen
authors.affiliation: Laboratory of epidemiology and biostatistics, Changhua-Christian hospital, 135, Nanhsiau street, Changhua, Taiwan, Republic of China.
authors.forename: Y-J
authors.initials: YJ
authors.lastname: Chang
authors.affiliation: Department of neurology, Changhua-Christian hospital, 135, Nanhsiau street, Changhua, Taiwan, Republic of China.
authors.forename: H-N
authors.initials: HN
authors.lastname: Sy
authors.affiliation: Department of medical imaging, Changhua-Christian hospital, 135, Nanhsiau street, Changhua, Taiwan, Republic of China.
authors.forename: W L
authors.initials: WL
authors.lastname: Chen
authors.affiliation: Department of neurosurgery, Changhua-Christian hospital, 135, Nanhsiau street, Changhua, Taiwan, Republic of China.
authors.forename: H-C
authors.initials: HC
authors.lastname: Yen
mesh_terms: D000368:Aged; D002544:Cerebral Infarction / Q000453:epidemiology* / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D014390:Tuberculosis, Meningeal / Q000150:complications*
keywords: Cerebral infarction; Infarctus cérébral; Meningitis; Méningite; Outcome; Risk assessment; Résultats; Tuberculose; Tuberculosis; Évaluation des risques