Neurological complications after tuberculous meningitis in a multi-state cohort in the United States.
OBJECTIVE
To assess the rate of neurological complications and mortality after tuberculous meningitis in the United States.


METHODS
The authors performed a retrospective cohort study of all patients 18years or older hospitalized for tuberculous meningitis in California between 2005 and 2010, New York between 2006 and 2012, and Florida between 2005 and 2012. Outcomes of interest were mortality and the following neurological complications: stroke, seizure, hydrocephalus requiring a ventriculoperitoneal shunt, vision impairment, and hearing impairment. Kaplan-Meier survival statistics were used to assess the cumulative rate of neurological complications and death. Cox proportional hazards regression was used to compare rates of complications in patients with and without human immunodeficiency virus (HIV) after adjustment for comorbidities.


RESULTS
806 patients with tuberculous meningitis were identified, among whom the cumulative rate of any complication or death was 55.4% (95% CI, 51.5-59.3%). More than two-thirds of complications occurred during the initial hospitalization for tuberculous meningitis. Individual neurological complications were not uncommon: the cumulative rate of stroke was 16.8% (95% CI, 14.0-20.0%), the rate of seizure was 18.8% (95% CI, 15.4-22.8%), and the rate of ventriculoperitoneal shunting was 8.4% (95% CI, 6.4-10.9%). Vision impairment occurred in 21.6% (95% CI, 18.5-25.1%) of patients and hearing impairment occurred in 6.8% (95% CI, 4.9-9.4%). The mortality rate was 21.5% (95% CI, 18.4-24.9%). Patients with HIV infection were not at increased risk of complications compared to patients without HIV (hazard ratio, 1.2; 95% CI, 0.9-1.6).


CONCLUSIONS
Tuberculous meningitis is associated with significant risk of neurological complications and death in the United States.
Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, United States; Department of Neurology, Weill Cornell Medicine, New York, NY, United States. Electronic address: alm9097@med.cornell.edu.
Alexander E
AE
Merkler
Department of Neurology, Columbia University Medical Center, New York, NY, United States.
Alexandra S
AS
Reynolds
Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, United States; Department of Neurology, Weill Cornell Medicine, New York, NY, United States.
Gino
G
Gialdini
Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, United States; Department of Neurology, Weill Cornell Medicine, New York, NY, United States; Department of Neurology, Columbia University Medical Center, New York, NY, United States.
Nicholas A
NA
Morris
Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, United States; Department of Neurology, Weill Cornell Medicine, New York, NY, United States.
Santosh B
SB
Murthy
Department of Neurology, Columbia University Medical Center, New York, NY, United States.
Kiran
K
Thakur
Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, United States; Department of Neurology, Weill Cornell Medicine, New York, NY, United States.
Hooman
H
Kamel
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology*; D016016:Proportional Hazards Models; D016896:Treatment Outcome; D014390:Tuberculosis, Meningeal / Q000150:complications* / Q000601:surgery; D014481:United States / Q000453:epidemiology; D017287:Ventriculoperitoneal Shunt / Q000379:methods; D055815:Young Adult
Outcome studies; Seizure; Stroke; Tuberculous meningitis; United States; Ventriculoperitoneal shunt