Late onset hydrocephalus in children with tuberculous meningitis

Abstract

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.

Magnetic Resonance Imaging Cerebrospinal Fluid Hydrodynamics in Patients with Meningitis

“…In these etiologies, the bacteria have a higher tendency to disrupt the blood-brain barrier, causing the inflammatory cells and proteins to leak into the subarachnoid space and form exudates. [23,24] is was supported by the cytochemical CSF analyses in these patients, which revealed significant CSF leukocytosis, CSF-ADA, and higher CSF protein concentrations (>50 mg/dl) attributed to the substantially wider CSF flow alterations. Conversely, in viral meningitis, milder dysfunction of blood brain barrier is observed with unremarkable CSF laboratory parameters accounting for lower alteration in CSF flow.…”

Abdominal Tuberculosis in a Child With Neuro Tuberculosis: Is it Due to Ventriculoperitoneal Shunt?

“…Tuberculous meningitis itself can theoretically be considered the source of infection spread and shunt complications in the peritoneal cavity including pseudocyst formation. 5 But the literature surrounding this is controversial, with no definite reported case of meningitis extension following VP shunt.…”