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Brainstem ischemic lesions on MRI in children with tuberculous meningitis: With diffusion weighted confirmation

dc.contributor.authorVan Der Merwe D.J.
dc.contributor.authorAndronikou S.
dc.contributor.authorVan Toorn R.
dc.contributor.authorPienaar M.
dc.date.accessioned2011-05-15T16:16:02Z
dc.date.available2011-05-15T16:16:02Z
dc.date.issued2009
dc.identifier.citationChild's Nervous System
dc.identifier.citation25
dc.identifier.citation8
dc.identifier.issn02567040
dc.identifier.other10.1007/s00381-009-0899-2
dc.identifier.urihttp://hdl.handle.net/10019.1/13600
dc.description.abstractIntroduction: The Western Cape in South Africa has one of the highest incidences of tuberculous meningitis (TBM) in the world. Despite therapy, the outcome in children with advanced TBM remains dismal. Magnetic resonance imaging (MRI) has been shown to be superior to computed tomography (CT) in demonstrating ischemia in TBM, especially of the brainstem. The objective of this study was to characterize brainstem lesions and association with clinical findings in children with TBM by using MRI. Materials and methods: CT and multiplanar MRI scans were performed in 30 children with proven TBM. From this group, a subgroup with radiological ischemic changes of the brainstem were identified. Radiological findings in these patients were then correlated with severity of disease, motor deficit, and outcome after 6 months. Results: Radiological brainstem abnormalities were identified in 14 out of 30 children. Thirty-eight brainstem lesions were confirmed to be ischemic. The severity of disease at presentation, degree of motor deficit, and developmental outcome after 6 months of the children with ischemic brainstem lesions was poorer compared to those children without brainstem involvement. However, both sensitivity and specificity of the MRI brainstem lesion detection for clinical outcome proved low. Conclusion: A significant percentage of children with TBM have ischemic brainstem lesions. These are poorly visualized on conventional CT. MRI scanning is more sensitive in detecting these lesions and localizing them. There appears to be some association between MRI-detected brainstem lesions and clinical outcome. The exact meaning of these lesions and their implication for the patient's management require further clarification. © 2009 Springer-Verlag.
dc.subjectadolescent
dc.subjectarticle
dc.subjectbrain development
dc.subjectbrain stem injury
dc.subjectchild
dc.subjectclinical article
dc.subjectcomputer assisted tomography
dc.subjectcontrolled study
dc.subjectdiagnostic accuracy
dc.subjectdiagnostic value
dc.subjectdiffusion weighted imaging
dc.subjectdisease severity
dc.subjectfemale
dc.subjecthuman
dc.subjectmale
dc.subjectmotor dysfunction
dc.subjectnuclear magnetic resonance imaging
dc.subjectpreschool child
dc.subjectpriority journal
dc.subjecttreatment outcome
dc.subjecttuberculous meningitis
dc.subjectAdolescent
dc.subjectBrain Ischemia
dc.subjectBrain Stem
dc.subjectChild, Preschool
dc.subjectDiffusion Magnetic Resonance Imaging
dc.subjectDisease Progression
dc.subjectFemale
dc.subjectFollow-Up Studies
dc.subjectHumans
dc.subjectMale
dc.subjectMovement Disorders
dc.subjectSensitivity and Specificity
dc.subjectTomography, X-Ray Computed
dc.subjectTuberculosis, Meningeal
dc.titleBrainstem ischemic lesions on MRI in children with tuberculous meningitis: With diffusion weighted confirmation
dc.typeArticle
dc.description.versionArticle


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