Tuberculous meningitis with hydrocephalus: A retrospective case series in a UK hospital

Abstract

Background

Patients may show signs of ventricular enlargement in the early stages of tuberculous meningitis (TBM), and the presence of hydrocephalus is a poor prognostic marker. There is limited evidence on the features which may suggest development of hydrocephalus in TBM (TBMH).

Methods

We studied hydrocephalus in adult patients with TBM requiring admission at a hospital in the UK between 2019 and 2024. Logistic regression was used to evaluate associations with poor outcome at 6-month follow up.

Results

11 of 20 (55.0%) patients developed TBMH. Among these, six (54.5%) had TBMH on the day of admission, whilst five (45.5%) patients developed TBMH following admission. Patients with TBMH on admission had lower Glasgow Coma Scale (GCS) scores on admission (10 vs 15, p < 0.05). Patients who developed TBMH after admission had higher protein levels in their CSF on admission (3 vs 1.4 g/dl, p < 0.05). Of patients with poor Glasgow outcome scale (GOS) scores at 6-month follow up, six (75%) had TBMH.

Conclusion

Abnormal GCS on admission was strongly associated with TBMH. Patients with no evidence of hydrocephalus on admission may subsequently develop TBMH and a high CSF protein count on admission may predict risk of hydrocephalus development. Early identification of patients at greatest risk of hydrocephalus may help improve outcomes.