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Prognostic value of CT-evident cerebral infarcts in adult patients with tuberculous meningitis and hydrocephalus treated with EVD.
MedLine Citation:
PMID:  23041069     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
INTRODUCTION: Tuberculous meningitis (TBM) is frequently complicated by hydrocephalus and cerebral infarction. Previous studies have shown radiological evidence of cerebral infarction in TBM to be an indicator of poor outcome in both adults and children. OBJECTIVES: To assess short-term mortality in adult patients with TBM and hydrocephalus treated with EVD, and to assess the prognostic value of cerebral infarction on admission computed tomography (CT) imaging within this cohort. METHODS: Retrospective case series based on adult intensive care unit admissions database, analysing demographic, clinical, diagnostic and radiological data against short-term mortality. RESULTS: 25 patients managed from 2005 to 2011 were identified. 3 patients were excluded. Mean age was 31 years. British Medical Research Council (BMRC) clinical severity grading was grade I in 9.1%, grade II in 31.8% and grade III in 59.1%. Short-term mortality was 68.2% overall. Cerebral infarction on admission scanning was seen in 10 patients (45.5%). Prevalence of infarcts was not significantly higher in HIV-positive patients (50.0% vs. 42.9%). Mortality in the group with infarcts was 100%, compared to 41.7% in the group without infarcts. Mortality in patients with an admission GCS of 8 or less was 91.7%. Mortality in the HIV-positive group was slightly higher, but this increase did not reach statistical significance (71.4% vs. 57.1% p=0.6). Univariate analysis showed presence of infarcts at admission, GCS≤8 at admission and age of 30 years or more to be significantly related to mortality. There was also a statistically significantly increased mortality according to BMRC grade. CONCLUSION: TBM with hydrocephalus requiring CSF diversion carries a significant shortterm mortality. Within this cohort, the group of patients who have CT-evident cerebral infarcts at admission have an even worse outcome, with a significantly higher short-term mortality prevalence.
Authors:
T Clemente Morgado; M Kinsky; H Carrara; S Rothemeyer; P Semple
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-10-3
Journal Detail:
Title:  World neurosurgery     Volume:  -     ISSN:  1878-8750     ISO Abbreviation:  World Neurosurg     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-8     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101528275     Medline TA:  World Neurosurg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012. Published by Elsevier Inc.
Affiliation:
University of Cape Town, Division of Neurosurgery, Groote Schuur Hospital, Cape Town, South Africa. Electronic address: tiagoclementemorgado@gmail.com.
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