The Correlation between hyponatremia and/or deranged cerebrospinal fluid glucose levels and the severity of childhood tuberculous meningitis
Date
2021-03
Authors
Journal Title
Journal ISSN
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Publisher
Stellenbosch : Stellenbosch University
Abstract
Introduction: Hyponatremia and/or hypoglycorrhachia are commonly encountered biochemical
derangements during the acute stage of childhood tuberculous meningitis (TBM). Few studies
have explored the correlation of the abovementioned derangements in relation to the staging of
the disease (severity), as well as being biomarkers for vascular ischemic events, hydrocephalus,
and seizures.
Objective: We aimed to identify the prevalence and the correlation between serum hyponatremia
(mild, moderate and severe) and/or hypoglycorrhachia in relation to clinical TBM features such
as stage of disease, seizures and stroke.
Design: A retrospective hospital based observational cohort study.
Results: The prevalence of hyponatremia was 344 out of 481 (71.5%) patients; 169 (49.1%) had
mild hyponatremia, 146 (42.4%) moderate hyponatremia and 29 (8.4%) severe hyponatremia.
Increasing severity of hyponatremia was associated with stroke (clinical persistent hemi or
quadriparesis with or without radiological infarcts), signs of brainstem dysfunction, cranial nerve
palsies and non- communicating hydrocephalus (all p<0.05). No association was identified in
relation to the age of the child, duration of symptoms or basal meningeal enhancement on
baseline CT imaging. The prevalence of hypoglycorrhachia was 72.9% (3 06 out of 420).
Children with hypoglycorrhachia were more likely to exhibited longer symptom duration prior to
admission (p=0.02); non-communicating hydrocephalus (p=0.05) as well as higher cerebrospinal
cell counts and protein levels (both p <0.01).
Conclusion: Hyponatremia and/or hypoglycorrhachia occur in more than two-thirds of children
with TBM. Increasing severity of hyponatremia is predictive of TBM disease complications such
as stroke and non-communicating hydrocephalus. CSF glucose depletion correlates with non-
communicating hydrocephalus and increased CSF inflammation.
AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar
AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar
Description
Thesis (MMed)--Stellenbosch University, 2021.
Keywords
Hyponatremia, Cerebrospinal Fluid, Tuberculosis in children, Tuberculous Meningitis, UCTD