Frequency of Hydrocephalus in Patients with Tuberculous Meningitis: A Prospective Observational Study at the Neurology Department of BMC Hospital
DOI:
https://doi.org/10.70749/ijbr.v3i6.2525Keywords:
Hydrocephalus, Tuberculous Meningitis, Neurological Complications, Prospective Observational Study, BMC Hospital.Abstract
Background: Tuberculous meningitis (TBM) is a severe neurological infection with hydrocephalus as a frequent and debilitating complication. This study aimed to determine the frequency, predictors, and outcomes of hydrocephalus in TBM patients admitted to a tertiary care center in Balochistan, Pakistan. Methods: This prospective observational cohort study analyzed 86 TBM patients at BMC Hospital's Neurology Department over six months. Inclusion required TBM diagnosis by modified Marais criteria, with exclusion of non-TBM meningitis or pre-existing hydrocephalus. Statistical analysis included descriptive statistics, chi-square/Fisher's exact tests, and multivariate logistic regression to identify predictors, adjusted for confounders. Results: The cohort comprised 86 TBM patients, predominantly male (60.5%) and urban residents (62.8%), with low socioeconomic status (54.7%). Headache (95.3), fever (88.4), and altered sensorium (57.0) were common. Hydrocephalus was identified in 58 patients (67.4; 95% CI: 56.8–76.5), with communicating type predominating (72.4) and moderate severity being most common (44.8). Management included VP shunts (55.2), with 62.1 showing post-intervention improvement. In-hospital mortality was 10.5%, and 38.4% had significant disability (MRS 3–5) at discharge. Independent predictors of hydrocephalus were altered sensorium (OR 8.2; p<0.001), CSF protein >200 mg/dL (OR 8.6; p<0.001), and basal exudates on MRI (OR 5.2; p=0.001). HIV coinfection was rare (2.3) and not a significant predictor (p=0.55). Conclusion: Hydrocephalus is highly frequent in TBM patients in this setting. Altered sensorium, elevated CSF protein, and basal exudates on MRI are crucial predictors. These findings emphasize the importance of early detection and aggressive management to improve outcomes in TBM-endemic regions like Balochistan, where the disease poses a significant public health burden.
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