Event Title

Cerebral infarctions predicts outcome in patients with tuberculous meningitis

Location

Auditorium Pond Side

Start Date

26-2-2014 10:30 AM

Abstract

Background: TB meningitis accounts for upto 10% of all Tb cases and is responsible for more than 40% deaths due to TB. Predictors of mortality in patients with central nervous system TB are not well defined.

Objective: This study was aimed to identify predictors of poor outcome (mortality) among patients with TB meningitis.

Methods: We reviewed 404 patients with diagnosis of TB meningitis at The Aga Khan university, Karachi. Patients were identified through medical records system at AKU by using ICD-9 codes. We reviewed 467 charts and included 404 patients in study. Incomplete information and non-availability of charts was main reason for non inclusion of 63 subjects. Poor outcome was defined as death at discharge. All patients underwent lumbar puncture and brain imaging (MRI;313 and CT scan; 91). Results: Out of 404 patients 209 were male. Mean age was 43 years. A history of positive TB contact was present in 64(16%). Conventional stroke risk factors were present in 162 (39%)patients. Motor weakness was present in 166 patients (40%). Miliary TB and lymph nodal TB was present in 55 (14%) in addition to CNS TB. 36% (147)patients had no infarction or tuberculoma on imaging, 15%(60) had infarction , 39%(158) patients tuberculomas and 10%(39) patients had both tuberculomas and infarctions on imaging. Overall, 25% (99) patients had infarcts on CT and MRI. Out of 99 patients with inafrctions 41 had single infarct while 58 had multiple infarcts. Acute infarction was present in 68 while chronic infarcts were present in 31 patients.56 patients had unilateral infarcts while 53 had bilateral infarcts. Overall mortality was 63(16%) at discharge. Mortality was 12% in patients without infarction or tuberculoma, 33% in patients with infractions alone, 10% in patients with tuberculoma alone and 23% in patients with both infarctions and tuberculoma. This difference was statistically significant (P<0.001).

Conclusion: Cerebral infarction is a common complication of Tb meningitis present in upto 25% patients. Presence on infarction on CT and MRI predicts significant mortality as compared to patients with no infract or tuberculoma and with tuberculoma alone.

Keywords: Miliary TB, Tuberculous meningitis, inafrctions, lumbar puncture

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Feb 26th, 10:30 AM

Cerebral infarctions predicts outcome in patients with tuberculous meningitis

Auditorium Pond Side

Background: TB meningitis accounts for upto 10% of all Tb cases and is responsible for more than 40% deaths due to TB. Predictors of mortality in patients with central nervous system TB are not well defined.

Objective: This study was aimed to identify predictors of poor outcome (mortality) among patients with TB meningitis.

Methods: We reviewed 404 patients with diagnosis of TB meningitis at The Aga Khan university, Karachi. Patients were identified through medical records system at AKU by using ICD-9 codes. We reviewed 467 charts and included 404 patients in study. Incomplete information and non-availability of charts was main reason for non inclusion of 63 subjects. Poor outcome was defined as death at discharge. All patients underwent lumbar puncture and brain imaging (MRI;313 and CT scan; 91). Results: Out of 404 patients 209 were male. Mean age was 43 years. A history of positive TB contact was present in 64(16%). Conventional stroke risk factors were present in 162 (39%)patients. Motor weakness was present in 166 patients (40%). Miliary TB and lymph nodal TB was present in 55 (14%) in addition to CNS TB. 36% (147)patients had no infarction or tuberculoma on imaging, 15%(60) had infarction , 39%(158) patients tuberculomas and 10%(39) patients had both tuberculomas and infarctions on imaging. Overall, 25% (99) patients had infarcts on CT and MRI. Out of 99 patients with inafrctions 41 had single infarct while 58 had multiple infarcts. Acute infarction was present in 68 while chronic infarcts were present in 31 patients.56 patients had unilateral infarcts while 53 had bilateral infarcts. Overall mortality was 63(16%) at discharge. Mortality was 12% in patients without infarction or tuberculoma, 33% in patients with infractions alone, 10% in patients with tuberculoma alone and 23% in patients with both infarctions and tuberculoma. This difference was statistically significant (P<0.001).

Conclusion: Cerebral infarction is a common complication of Tb meningitis present in upto 25% patients. Presence on infarction on CT and MRI predicts significant mortality as compared to patients with no infract or tuberculoma and with tuberculoma alone.

Keywords: Miliary TB, Tuberculous meningitis, inafrctions, lumbar puncture