SERIAL CT SCANNING IN CHILDHOOD TUBERCULOUS MENINGITIS - PROGNOSTIC FEATURES IN 198 CASES

Serial cranial computed tomographic (CT) scanning and intracranial pre ssure monitoring were performed on 198 children with stage II and III tuberculous meningitis. The aims of the study were to document the cou rse of tuberculous hydrocephalus during medical and surgical treatment , as well as the prognostic significance of parenchymal changes in the brain as demonstrated by CT. Lumbar cerebrospinal fluid pressure was monitored continuously for a 1-hour period in all patients on admissio n and at weekly intervals in patients with communicating hydrocephalus for the Ist month of treatment. Cranial CT scanning was done on admis sion and repeated in survivors after 1 month and again after 6 months of antituberculous therapy. The raised intracranial pressure of 112 ch ildren with communicating hydrocephalus, as demonstrated by air-enceph alography, was treated medically (with daily acetazolamide and furosem ide) for 1 month. Thirty-one children with noncommunicating hydrocepha lus were referred for immediate ventriculoperitoneal shunting. No sign ificant difference was found in the eventual ventricular size or clini cal outcome between the two treatment groups. Lumbar cerebrospinal flu id pressure changes in the children with communicating hydrocephalus c losely followed changes in the degree of hydrocephalus during the cour se of treatment. The main cause of permanent neurologic disability was basal ganglia infarction, which occurred unilaterally in 21% and bila terally in 10% of patients on admission and developed in a further 22% of children during treatment. A prominent subarachnoid space, which w as seen on the CT scan of 36% of patients after the 1st month of treat ment and which reverted to normal, probably relates to the poor nutrit ional state of these patients on admission. Serial CT scanning was fou nd to be valuable in defining the respective roles of raised intracran ial pressure and parenchymal disease in the outcome of tuberculous men ingitis.