title: Structural deficits and cognitive impairment in tuberculous meningitis.
abstract: BACKGROUND
  Chronic neuropsychological sequelae may occur in patients with tuberculous meningitis (TBM). The impact of structural abnormalities on the clinical performance of patients with TBM is unknown. This study applied the Diffeomorphic Anatomical Registration Through Exponentiated Lie Algebra (DARTEL) voxel-based morphometry (VBM) to determine if gray matter deficits in TBM are associated with acute presentations and chronic cognitive impairment.
  
  
  METHODS
  Seventeen patients with TBM who discontinued their anti-TB therapy for more than six months, and 17 age-, sex-, and education-matched healthy subjects were enrolled. Differences in gray matter volume (GMV) between patients and healthy controls were investigated using DARTEL-VBM to determine structural abnormalities. Disease severity during the acute stage was scored by clinical profiles and conventional imaging findings. Correlations among chronic structural deficits, cognitive impairment, and initial disease severity were assessed.
  
  
  RESULTS
  The patients with TBM had worse neuropsychological subtest performances than the healthy controls. Compared to the controls, the patients showed smaller GMVs in the right thalamus, right caudate nucleus, right superior and middle temporal gyrus, right precuneus, and left putamen (p < 0.001). The smaller GMVs in the right thalamus, right superior temporal gyrus, right precuneus, left putamen, and right caudate nucleus (p < 0.05) were further associated with worse cognitive function. More severe initial disease also correlated with smaller GMVs in the right caudate nucleus (p < 0.05).
  
  
  CONCLUSIONS
  Multiple domain cognitive impairment may persist in patients with chronic TBM even after appropriate treatment. Worse initial disease severity may contribute to the vulnerability of brain tissue to damage, with subsequent neuropsychological consequences.
authors.affiliation: Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, 83305, Taiwan. suring.tw@gmail.com.|Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan. suring.tw@gmail.com.
authors.forename: Hsiu-Ling
authors.initials: HL
authors.lastname: Chen
authors.affiliation: Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan. chlu99@adm.cgmh.org.tw.
authors.forename: Cheng-Hsien
authors.initials: CH
authors.lastname: Lu
authors.affiliation: Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, 83305, Taiwan. mr6777@adm.cgmh.org.tw.
authors.forename: Ching-Di
authors.initials: CD
authors.lastname: Chang
authors.affiliation: Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, 83305, Taiwan. pachin1117@gmail.com.
authors.forename: Pei-Chin
authors.initials: PC
authors.lastname: Chen
authors.affiliation: Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, 83305, Taiwan. sperfect@msn.com.
authors.forename: Meng-Hsiang
authors.initials: MH
authors.lastname: Chen
authors.affiliation: Department of Radiology, Yuan's General Hospital, Kaohsiung, Taiwan. almhsu36@hotmail.com.
authors.forename: Nai-Wen
authors.initials: NW
authors.lastname: Hsu
authors.affiliation: Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan. dargonchow@gmail.com.
authors.forename: Kun-Hsien
authors.initials: KH
authors.lastname: Chou
authors.affiliation: Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Chiayi, Chang Gung University College of Medicine, Chiayi, Taiwan. weiming276@gmail.com.
authors.forename: Wei-Ming
authors.initials: WM
authors.lastname: Lin
authors.affiliation: Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan. chingpolin@gmail.com.|Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan. chingpolin@gmail.com.
authors.forename: Ching-Po
authors.initials: CP
authors.lastname: Lin
authors.affiliation: Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, 83305, Taiwan. u64lin@yahoo.com.tw.
authors.forename: Wei-Che
authors.initials: WC
authors.lastname: Lin
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003071:Cognition; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D066128:Gray Matter / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011859:Radiography; D012720:Severity of Illness Index; D014390:Tuberculosis, Meningeal / Q000150:complications / Q000473:pathology*; D055815:Young Adult