title: Clinical characteristics and neurodevelopmental outcomes of children with tuberculous meningitis and hydrocephalus.
abstract: Tuberculous meningitis (TBM) is a lethal and commonly occurring form of extra-pulmonary tuberculosis in children, often complicated by hydrocephalus which worsens outcome. Despite high mortality and morbidity, little data on the impact on neurodevelopment exists. We examined the clinical characteristics, and clinical and neurodevelopmental outcomes of TBM and hydrocephalus.
  
  
  
  Demographic and clinical data (laboratory and radiological findings) were prospectively collected on children treated for probable and definite TBM with hydrocephalus. At 6 months, clinical outcome was assessed using the Paediatric Cerebral Performance Category Scale and neurodevelopmental outcome was assessed with the Griffiths Mental Development Scale - Extended Version.
  
  
  
  Forty-four patients (median age 3y 3mo, range 3mo-13y 1mo, [SD 3y 5mo]) were enrolled. The mortality rate was 16%, three patients (6.8%) were in a persistent vegetative state, two were severely disabled (4.5%), and 11 (25%) suffered mild-moderate disability. All cases demonstrated neurodevelopmental deficits relative to controls. Multiple or large infarcts were prognostic of poor outcome.
  
  
  
  Neurological and neurodevelopmental deficits are common after paediatric TBM with hydrocephalus, and appear to be related to ongoing cerebral ischaemia and consequent infarction. The impact of TBM on these children is multidimensional and presents short- and long-term challenges.
authors.affiliation: Division of Neurosurgery, Paediatric Neurosurgery, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.|Clinical and Infectious Disease Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Ursula K
authors.initials: UK
authors.lastname: Rohlwink
authors.affiliation: Division of Developmental Paediatrics, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
authors.forename: Kirsty
authors.initials: K
authors.lastname: Donald
authors.affiliation: Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
authors.forename: Bronwyn
authors.initials: B
authors.lastname: Gavine
authors.affiliation: Division of Neurosurgery, Paediatric Neurosurgery, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
authors.forename: Llewellyn
authors.initials: L
authors.lastname: Padayachy
authors.affiliation: Paediatric Neurology, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
authors.forename: Jo M
authors.initials: JM
authors.lastname: Wilmshurst
authors.affiliation: Division of Neurosurgery, Paediatric Neurosurgery, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
authors.forename: Graham A
authors.initials: GA
authors.lastname: Fieggen
authors.affiliation: Division of Neurosurgery, Paediatric Neurosurgery, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Figaji
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000150:complications*; D007223:Infant; D008297:Male; D009422:Nervous System Diseases / Q000209:etiology* / Q000503:physiopathology; D065886:Neurodevelopmental Disorders / Q000209:etiology* / Q000503:physiopathology; D017063:Outcome Assessment, Health Care; D014390:Tuberculosis, Meningeal / Q000150:complications* / Q000188:drug therapy / Q000401:mortality