Document Detail

Shunt surgery for hydrocephalus in tuberculous meningitis: a long-term follow-up study.
MedLine Citation:
PMID:  1984509     Owner:  NLM     Status:  MEDLINE    
Hydrocephalus is a common complication of tuberculous meningitis. Case studies of 114 patients with tuberculous meningitis and hydrocephalus, who underwent shunt surgery between July, 1975, and June, 1986, were reviewed to evaluate the long-term outcome and to outline a management protocol for these patients based on the results. Seven factors were studied in each case: 1) age at admission; 2) grade on admission (I to IV, classified by the authors; Grade I being the best and Grade IV being the worst); 3) duration of alteration of sensorium; 4) cerebrospinal fluid (CSF) cell content at initial examination; 5) CSF protein levels at initial examination; 6) number of shunt revisions required; and 7) the necessity for bilateral shunts. During a long-term follow-up period ranging from 6 months to 13 years (mean 45.6 months), the mortality rate was 20% for patients in Grade I; 34.7% for patients in Grade II; 51.9% for patients in Grade III; and 100% for patients in Grade IV. Only the grade at the time of admission was found to be statistically significant in determining final outcome (p less than 0.001). Based on these results, the authors advocate early shunt surgery for Grade I and II patients. For patients in Grade III, surgery may be performed either if external ventricular drainage causes an improvement in sensorium or without selection. All patients in Grade IV should undergo external ventricular drainage and only those who show a significant change in their neurological status within 24 to 48 hours of drainage, should have shunt surgery.
R Palur; V Rajshekhar; M J Chandy; T Joseph; J Abraham
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  74     ISSN:  0022-3085     ISO Abbreviation:  J. Neurosurg.     Publication Date:  1991 Jan 
Date Detail:
Created Date:  1991-01-28     Completed Date:  1991-01-28     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  64-9     Citation Subset:  AIM; IM    
Department of Neurological Sciences, Christian Medical College and Hospital, Vellore, India.
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MeSH Terms
Cerebrospinal Fluid Shunts*
Child, Preschool
Follow-Up Studies
Hydrocephalus / etiology,  surgery*
Infant, Newborn
Middle Aged
Time Factors
Tuberculosis, Meningeal / complications*

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