Can CT predict the level of CSF block in tuberculous hydrocephalus?

Heemskerk

Clinical Infectious Diseases

et al. 2016

Section: Management and Monitoringmentioning

confidence: 99%

Standardized Methods for Enhanced Quality and Comparability of Tuberculous Meningitis Studies

Heemskerk

Clinical Infectious Diseases

et al. 2016

“…Air-encephalography remains the most reliable way of determining the level of CSF obstruction. [9] For example, in the cases where the CT scan shows dilatation of the lateral and third ventricles without a dilated fourth ventricle, it can safely be presumed that the hydrocephalus is due to obstruction to the CSF pathways in the region of the aqueduct. But if all the ventricles are dilated, then it is difficult to determine whether the hydrocephalus is due to obstruction of the fourth ventricular outlets or due to an obstruction to the CSF pathways in the basal subarachnoid spaces, unless the fourth ventricle is seen to be in communication with the cisterna magna.…”

Section: Imagingmentioning

confidence: 99%

Management of hydrocephalus in patients with tuberculous meningitis

2009

Hydrocephalus is one of the commonest complications of tuberculous meningitis (TBM) occurring in up to 85% of children with the disease. It is more severe in children than in adults. It could be either of the communicating type or the obstructive type with the former being more frequently seen. The Vellore grading system for clinical grading of patients with TBM and hydrocephalus with grade I being the best grade and grade IV being the worst grade has been validated by several authors. The management of hydrocephalus can include medical therapy with dehydrating agents and steroids for patients in good grades and those with communicating hydrocephalus. However, surgery is required for patients with obstructive hydrocephalus and those in poor grades. Surgery can involve either a ventriculo-peritoneal shunt or endoscopic third ventriculostomy (ETV). Complications of shunt surgery in patients with TBM and hydrocephalus are high with frequent shunt obstructions and shunt infections requiring repeated revisions. ETV has variable success in these patients and is generally not advisable in patients in the acute stages of the disease. Mortality on long-term follow up has been reported to vary from 10.5% to 57.1% in those with altered sensorium prior to surgery and 0 to 12.5% in patients with normal sensorium. Surgery for patients in Vellore grade IV is usually associated with a poor outcome and high mortality and therefore, its utility in these patients is debatable.

“…[4] The main cause is inflammatory exudates occupying the subarachnoid spaces or the ventricular pathways. In the earlier stages of the disease, the thick gelatinous exudates block the subarachnoid spaces in the base of the brain leading to communicating hydrocephalus.…”

Section: Discussionmentioning

confidence: 99%

Late onset hydrocephalus in children with tuberculous meningitis

Sharma

Shah

Patel

2016

J Family Med Prim Care

Hydrocephalus is a known complication of tuberculous meningitis (TBM). It is almost always present in patients who have had the disease for four to six weeks. However, hydrocephalus can also develop later in the disease course as seen in our 3 patients. All 3 patients had multi-drug resistant (MDR) tuberculosis (TB) and developed hydrocephalus after variable time after starting second line anti-tuberculous therapy (ATT). A 7 years old girl had hydrocephalus at onset of TBM and was shunted but the hydrocephalus increased in size after 6 months of being on second line ATT in spite of a patent ventricular peritoneal (VP) shunt. Hydrocephalus responded to oral acetazolamide. Other 2 patients, a 2 years old girl and 3½ years old boy developed hydrocephalus after being on treatment for 14 months. Both required insertion of VP shunt. Thus, in patients with MDR-TB, hydrocephalus may develop as late onset phenomenon and a neurological examination would be essential in each visit to the hospital.