Clinical, laboratory and Imaging characteristics in patients with Neurological deficits in Tuberculous meningitis and its effect on patient outcome

Abstract

Purpose: Focal neurological deficits occur in 15–57% of patients with Tuberculous meningitis and are important determinants of patient outcome. This study was performed to study the clinical, laboratory and imaging characteristics in patients with neurological deficits in Tuberculous meningitis and to assess its impact on patient outcome at one year Methods & Materials: A total of 209 patients, diagnosed to have Tuberculous meningitis by consensus case definition were prospectively recruited, evaluated and followed for 1 year. These were grouped into patients with and without neurological deficits. Demographic, clinical, laboratory and neuroimaging findings were compared between the two groups and analyzed for significance by chi square test. Multinomial logistic regression was done to assess patient outcome at 1 year. Results: Any neurological deficit was present in 92 (44%) patients of Tuberculous meningitis. Motor deficit was seen in 68 (32.5%), cranial nerve palsy in 62 (29.6%) and cerebellar signs in 17 (8%) alone or in combination. The neurological deficits were significantly associated with advanced stage of disease, presence of seizures, multi drug resistance, basal meningeal enhancement, hydrocephalus and infarcts. At 1 year follow up, 26 (28.25%) patients with any deficit had died, 44 (47.8%) patients had residual neurological sequeale whereas 22 (24%) patients recovered. Basal meningeal enhancement and infarcts in the distribution of middle cerebral artery were significantly associated with poor prognosis. Conclusion: Neurological deficits occurred in 44% of patients with Tuberculous meningitis and were significantly associated with death and residual neurological sequeale in comparison to recovery at 1 year. The possibility of cerebral infarction, basal meningeal enhancement must be considered while treating patients with TB meningitis who develop focal neurological signs as these patients are associated with worst prognosis.