Prognostic factors of neurological sequel in adult patients with tuberculous meningitis.

OBJECTIVE: To evaluate the predictors of neurological sequel in tuberculous meningitis (TBM). METHODS: This study was carried out at the Department of Clinical Microbiology and Infectious Diseases, Haseki Training and Research Hospital, Istanbul, Turkey, between January 1998 and March 2009. Neurological sequels at 6 months of 160 adult patients with TBM who had been followed up were assessed retrospectively. The prognostic role of various demographic, clinical, laboratory, and radiological findings on admission, in prediction of neurological sequel development, were studied using a multivariate logistic regression. Clinical and therapeutic outcomes at 6 months were determined using a modified Barthel Index. RESULTS: Twenty-seven (17%) patients died and 20 (13%) survivors had neurological sequelae at 6 months. Cranial nerve palsy, presence of tuberculoma, younger age, and basal meningitis were found to be significant predictors of neurological sequelae in univariate analysis, but only younger age (odds ratio [OR] 2.9, 95% confidence intervals [CI] 1.0-8.6, p=0.049), cranial nerve palsy (OR 3.9, 95% CI 1.8-8.8, p=0.001), and presence of tuberculoma (OR 1.9, 95% CI 1.0-4.2, p=0.048) were found to be significant predictors using multivariable logistic regression analysis. CONCLUSION: Neurological sequelae were more common in patients with tuberculoma and cranial nerve palsy on admission. Development of neurological complications may be seen despite timely and effective anti-tuberculous therapy especially in younger patients.

Sensorineural hearing loss in neurobrucellosis.

Neurobrucellosis (NB) is a rare clinical presentation of brucellosis. This form is hard to diagnose because of a lack of definite diagnostic criteria, and its treatment is also hard. The clinical spectrum may cover a span between non-specific neurological symptoms to a severe meningoencephalitis. We report 3 patients with NB, whose main complaint was sensorineural hearing loss (SNHL) who were followed up at our hospital for 3 years. We diagnosed NB by positive CSF cultures in 2 patients and by a positive brucella IgG agglutination titer in blood and CSF in the third. Sensorineural hearing loss is a rare complication of NB, which has not attracted enough attention among known manifestations. Neurologists and otologists should be aware of this symptom as a probable clinical presentation of brucellosis.

Evaluation of 121 adult cases of tuberculous meningitis.

OBJECTIVE: To evaluate serious complications of tuberculous meningitis (TBM), resulting from difficulties in diagnosis and treatment of the disease. METHODS: Clinical and laboratory findings of 121 patients with TBM followed-up between the years 1998 and 2005 were evaluated retrospectively in Haseki Training and Research Hospital, Istanbul, Turkey. The patients were diagnosed by history, physical examination findings, CSF findings, CSF culture, and radiological imaging techniques, and were treated with isoniazid, rifampicin, ethambutol, pyrazinamide, and dexamethasone. RESULTS: The age distribution of 121 patients was 15-70 (31+/-14.0 years). Most frequent complaint on admission was headache, and most frequent findings were nuchal rigidity, alteration in consciousness, and fever. Forty-four patients had active pulmonary tuberculosis, 33 had a history of pulmonary tuberculosis, 24 had a family member with active pulmonary tuberculosis, and one had HIV infection. Mycobacterium tuberculosis was isolated from CSF in 52 patients (43%). At cranial imaging, basal meningitis, tuberculoma, and hydrocephalus were the most common findings. Of 121 patients who were treated, 69 recovered completely, 40 recovered with neurological sequels, and 12 patients died. Ten of the deceased had stage III TBM. CONCLUSION: Tuberculous meningitis is one of the most severe clinical forms of tuberculosis. Mortality is directly related with the stage of the disease.