Introduction-Data on single photon emission computed tomography (SPECT) in
tuberculous meningitis are lacking and prompted this study. SPECT findings
in tuberculous meningitis are reported and correlated with clinical and rad
iological findings.
Patients and methods-Seventeen patients with tuberculous meningitis that wa
s diagnosed on clinical, radiological, and laboratory criteria have been in
cluded. Their age ranged between 5 and 62 years and four of them were femal
e. Computed tomography and/or magnetic resonance imaging (MRI) and SPECT us
ing Tc-99m-ethylene cystine dimer were performed in all the patients. On th
e basis of Barthel index (BI) score the patients' outcome was defined as co
mplete (BI = 20), partial (BI = 19-12), and poor recovery (BI<12).
Result-Eleven patients were in stage III and three each in stage II and sta
ge I tuberculous meningitis. Two patients had hemiplegia and five quadriple
gia. Computed tomography was abnormal in 11 out of 16 patients and revealed
hydrocephalus in nine, basal exudates, infarction in subcortical white mat
ter and basal ganglia in six patients each, frontal cortical infarction in
one, and granulomata in three patients. Cranial MRI was carried out in four
patients and revealed multiple granulomata, hydrocephalus, and brainstem i
nfarction in two patients each. SPECT studies were abnormal in all except t
wo patients and revealed hypoperfusion of the basal ganglia in 14, cortical
hypoperfusion in 10, and midbrain hypoperfusion in one patient. At the thr
ee month follow up four patients had died, five had poor, three partial, an
d five complete recovery. The SPECT studies were more frequently abnormal c
ompared with computed tomography but did not correlate with stage of mening
itis or outcome.
Conclusion-In tuberculous meningitis subcortical and cortical hypoperfusion
is common but it does not correlate with stage of meningitis or three mont
h outcome.