Serial lumbar CSF pressure measurements and cranial computed tomographic findings in childhood tuberculous meningitis

Intracranial pressure (ICP) was monitored in 218 consecutive children with hydrocephalus secondary to tuberculous meningitis (TBM). All children under went cranial computerized tomographic (CT) scanning and continuous lumbar c erebrospinal (CSF) pressure monitoring on admission. Noncommunicating hydro cephalus (37 children), as determined by air encephalography, was treated b y ventriculoperitoneal (VP) shunting and communicating hydrocephalus (181 c hildren), by means of daily acetazolamide and frusemide. Response of ICP to treatment in the group with communicating hydrocephalus was assessed by me ans of repeated CSF pressure monitoring and CT scanning. One hundred and ei ghty-five of the 218 patients survived the ist month of treatment. The aim of this study was the retrospective determination of (1) the relationship b etween ICP measurements and CT findings on admission and (2) the characteri stics of the ICP recording which correlated best with the CT criteria of co mpensated hydrocephalus after the 1st month of treatment. No relationship w as found between the level of base-line CSF pressure and the degree of hydr ocephalus, as demonstrated by CT scanning, on admission. Seventy-five per c ent of the patients with communicating hydrocephalus that survived the ist month of treatment complied with the CT criteria for compensated hydrocepha lus. All these patients had a baseline CSF pressure below 15 mmHg and absen ce of high-amplitude B waves on the pressure recording done at the end of t he ist month. In this study repeated lumbar CSF pressure monitoring proved to be an effective instrument to assess the response of communicating tuber culous hydrocephalus to medical treatment and also accurately predicted the timing of compensation of the hydrocephalus.