Study of neurological deficits in patients with tuberculous meningitis and its association with urodynamic study
Keywords:Hemiparesis, Meningeal enhancement, Tuberculosis meningitis, Uroflowmetry
Background: Tuberculous meningitis (TBM) is the main form of tuberculosis that affects the central nervous system and is associated with high rates of death and disability. The objective of this study was to study neurological symptoms in TBM patients using clinical diagnosis and MRI of spine and comparing with urodynamic study.
Methods: Fifty one patients diagnosed with TBM were studied in Neurology Department of KGM Medical University, Lucknow. Uroflowmetry and urodynamic study were done to divide the patients into normal and abnormal. A detailed history taking, general physical and neurological examination using MRI spinal cord was done and recorded on a predesigned proforma.
Results: Visual impairment, hemiparesis, paraparesis, abnormal tone and reflexes in lower limbs showed significant association with abnormality in urodynamic study. MRI spine showed significant relationship of spinal meningeal enhancement, lumbosacral arachnoiditis, with abnormal urodynamic study.Conclusions: We found a significant association between neurological symptoms and abnormal urodynamic
World Health Organization. Global tuberculosis report, 2015. Available at: https://www.who.int/tb/publications/global_report/gtbr15_main_text.pdf.
Chiang SS, Khan FA, Milstein MB, Tolman AW, Benedetti A, Starke JR et al. Treatment outcomes of childhood tuberculous meningitis: a systematic review and meta-analysis. Lancet Infect Dis 2014;14(10):947-57.
Marais S, Pepper DJ, Schutz C, Wilkinson RJ, Meintjes G. Presentation and outcome of tuberculous meningitis in a high HIV prevalence setting. PLoS One. 2011;6(5):e20077.
Khoo JLS, Lau KY, Cheung CM, Tsoi Tak. Central Nervous System Tuberculosis. J HK Coll Radiol. 2003;6:217-22.
Srivastava T, Kochar DK. Asymptomatic spinal arachnoiditisin patients with tuberculous meningitis. Neuroradiology. 2003;45(10): 727-9.
Singh B, Garg RK, Singh MK, Verma R, Malhotra HS, Jain A, et al. Computed tomography angiography in patients with tuberculous meningitis. J Infect. 2012;64(6):565-72.
Misra UK, Kalita J, Srivastava M. Prognosis of tuberculous meningitis: a multivariate analysis. J Neurol Sci. 1996;137(1):57-61.
Kumarvelu S, Prasad K, Khosla A, Behari M, Ahuja GK. Randomized controlled trial of dexamethasone in tuberculous meningitis. Tuber Lung Dis. 1994;75(3): 203-7.
Pehlivanoglu F, Yasar KK, Sengoz G. Tuberculous Meningitis in adults: a review of 160 Cases. Scientific World J. 2012;2012:169028.
Thwaites GE, Band ND, Dung NH. Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults. N Engl J Med. 2004;351(17):1741-51.
Podnar S, Trsinar B, Vodusek B. Bladder dysfunction in patients with caudaequina lesions. Neurourol Urodyn. 2006;25(1):23-31.
Bartolin Z, Savic I, Persec Z. Relationship between clinical data and urodynamic findings in patients with lumbarintervertebral disk protrusion. Urol Res. 2002;30(4):219-22.
Mosdal C, Iversen P, Iversen-Hansen R. Bladder neuropathy in lumbar disc disease. Acta Neurochir (Wien). 1979;46(3):281-6.
Anuradha HK, Garg RK, Agarwal A, Sinha MK, Verma R, Singh MK, et al. Predictors of stroke in patients of tuberculous meningitis and its effect on the outcome. QJM. 2010;103(9):671-8.
Sinha MK, Garg RK, Anuradha HK, Agarwal A, Singh MK, Verma R, et al. Vision impairment in tuberculous meningitis: Predictors and prognosis. J Neurol Sci. 2010;290(1-2):27-32.
Kalita J, Misra UK. Outcome of tuberculous meningitis at 6 and 12 months: a multiple regression analysis. Int J Tuberc Lung Dis. 1999;3(3):261-5.
Dastur DK, Manghan, DK Udani PM. Pathology and pathogenesis mechanism in neuro tuberculosis. Radiolclin North Am. 1995;33(4):733-92.
Dastur DK, Wadia NH. Spinal Meningitides with Radiculo-Myelopathy. Part 2. Pathology and Pathogenesis. J Neurol Sci. 1969;8(2):261-97.