Severe hyponatremia and MRI point to diagnosis of tuberculous meningitis in the Southwest USA

Benson, Stephanie Michelle; Narasimhamurthy, Rashmi

doi:10.1136/bcr-2013-009885

Cited by 4 publications

(4 citation statements)

References 12 publications

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“…For a scoring system comparing TBM with VM, the Hristea scoring system 13 included CSF and clinical findings, duration of illness, and neurological status. Following this study, many subsequent published studies emphasized the importance of hyponatremia, which occurs in 30%–50% of patients in the first month of treatment, 15 33 as well as cranial nerve palsy, with the abducens (6th) nerve the most frequently affected. 16 In the present study, we have tried to create a new scoring system for differential diagnosis between TBM and VM.…”

Section: Discussionmentioning

confidence: 82%

“…For decades, there have been many descriptions of assays testing meaningful factors in TBM, such as adenosine deaminase (ADA), lactic acid and LDH in CSF, procalcitonin, serum sodium, and cranial nerve palsy symptoms, among others. 15 16 31 32 33 34 However, each factor alone cannot distinguish between TBM and other forms of meningitis. Therefore, before TB culture results can be obtained, a simple diagnostic system that synthesizes statistically meaningful predictors is necessary.…”

Section: Discussionmentioning

confidence: 99%

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A New Scoring System for the Differential Diagnosis between Tuberculous Meningitis and Viral Meningitis

et al. 2018

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BackgroundTuberculous meningitis (TBM) is associated with high mortality and morbidity despite administering anti-tuberculous chemotherapy to the patients. Differential diagnosis between TBM and viral meningitis (VM) is difficult in some clinical situations.MethodsWe reviewed and analyzed records of adult patients who were admitted and diagnosed with TBM or VM at a tertiary hospital in Korea, between January 2006 and December 2015. Diagnostic criteria for TBM were categorized into three groups: definite, probable, and possible TBM. The VM group included patients with no evidence of other meningitis who achieved complete recovery with only conservative treatments. Clinical, laboratory and radiological findings, as well as outcomes, were compared between the TBM and VM groups.ResultsNinety-eight patients were enrolled. Among the study patients, 47 had TBM and 51 had VM. Based on univariate analysis and multivariate logistic regression, sodium < 135 mmol/L in serum (hyponatremia), lactate dehydrogenase > 70 (U/L) in cerebrospinal fluid (CSF), protein > 160 (mg/dL) in CSF, voiding difficulty, and symptoms of cranial nerve palsy were significant predictive factors for TBM in the final model. We constructed a weighted scoring system with predictive factors from multiple regression analyses. Receiver operating characteristic curve analyses and decision tree analyses were plotted to reveal an optimum cutoff point as 4 with this scoring system (range: 0–13).ConclusionFor differential diagnosis between TBM and VM, we created a new weighted scoring system. This scoring system and decision tree analysis are simple and easy to apply in clinical practice to differentiate TBM from VM.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

A New Scoring System for the Differential Diagnosis between Tuberculous Meningitis and Viral Meningitis

et al. 2018

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“…Another study carried out by Goos M et al reported 53% prevalence of hyponatremia in patients with tuberculous meningitis which is almost similar with our findings 9 . According to previous research, the correlation between hyponatremia and tuberculous bacterial meningitis was 44.7%, with cerebral salt wasting syndrome affecting 50% of patients and the SIADH affecting 9% 10 . A previous study done by Jong et al reported low prevalence (37%) of hyponatremia in patients with tuberculous meningitis which is not in accordance with our study 11 .ss…”

Section: Discussionmentioning

confidence: 90%

Frequency of Hyponatremia in Tuberculous Meningitis Patients

Kakar¹,

Azim²,

Baqi³

et al. 2022

PJMHS

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Back Ground: A severe inflammation of the meninges is often referred to as meningitis. Hyponatremia has been associated with tuberculous meningitis in numerous studies. Objective: To assess the frequency of hyponatremia in tuberculous meningitis patients Methodology: This cross sectional study was carried out at the department of Neurology Bolan Medical Complex Hospital, Fatima Jinnah Institute of Chest Diseases and Sheikh Khalifa Bin Zayyed Al Nahyan Medical Complex Quetta for duration of one year from September 2021 to September 2022. All the required data like name, gender and presence or absence of hyponatremia were documented in a special proforma designed for this research. Data analysis was carried out by using SPSS version 23. Results: In our study, totally 210 patients were included. The male participants in our study were 94 (44.76%) while female participants were 116 (55.24%). The mean sodium level in serum was observed to be 133 with SD of ± 4.29. The overall frequency of hyponatremia in tuberculous meningitis patients was 113 (53.81%). Conclusion: Our study concludes that the frequency of hyponatremia in tuberculous meningitis patients was very high (53.81%). Hyponatremia may have serious implications, including serious neurological problems and death, if it is not properly diagnosed and treated early Keywords: Frequency, hyponatremia, tuberculous meningitis

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“…One of the cases is of anterior callosal and frontal tuberculoma presenting with chronic psychosis and recent onset catatonia [5]. Another case where in mood disturbances in the form of depressive symptoms, cognitive difficulties and hyponatremia were presenting features of tubercular meningitis [6]. A case series about unusual presentations of tubercular meningitis had one of the cases presenting as paranoid psychosis [7].…”

Section: Discussionmentioning

confidence: 99%

Affective Psychosis: A Rare Presentation of Tubercular Meningitis in a Tertiary Care Hospital

Pv¹,

Shetageri²,

Kumar³

et al. 2017

JCR

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Background: Tuberculosis (TB) is a disease which has been affecting humanity since archaic ages. Although tubercular meningitis (TBM) is the least commonly observed form of extra-pulmonary TB (5-15%), it is the most severe form in terms of mortality and morbidity. Case Report: A young female, 2 months post-partum, and a diagnosed case of miliary TB on irregular ATT since one and half month presented with mood and psychotic symptoms. There was no significant improvement noted with regular ATT, antipsychotic and mood stabilizer. Further evaluation revealed TBM with tuberculoma on treatment of which psychiatric symptoms subsided. Conclusion: Atypical presentation of TBM is not uncommon in developing nations like India. We report one such case presenting with syndromal psychiatric symptoms and signs. This report is intended to make psychiatrists aware of the unusual clinical presentations of tubercular meningitis.

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Severe hyponatremia and MRI point to diagnosis of tuberculous meningitis in the Southwest USA

Cited by 4 publications

References 12 publications

A New Scoring System for the Differential Diagnosis between Tuberculous Meningitis and Viral Meningitis

A New Scoring System for the Differential Diagnosis between Tuberculous Meningitis and Viral Meningitis

Frequency of Hyponatremia in Tuberculous Meningitis Patients

Affective Psychosis: A Rare Presentation of Tubercular Meningitis in a Tertiary Care Hospital

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