Clinical determinants distinguishing communicating and non-communicating hydrocephalus in childhood tuberculous meningitis at presentation
ABSTRACT Introduction: Hydrocephalus occurs in up to 80% of children with tuberculous meningitis (TBM), of which the majority (70-80%) is of a communicating nature. Communicating hydrocephalus develops when cerebrospinal fluid (CSF) obstruction occurs at the level of the tentorium, whilst non-communicating hydrocephalus emanates from basal exudates that obstruct the outflow foramina of the fourth ventricle. Identifying the type of hydrocephalus is of critical importance since communicating hydrocephalus can be medically treated with diuretics whilst non-communicating hydrocephalus requires surgical CSF diversion. Conventional neuroimaging does not allow differentiation of the type of hydrocephalus. In resource-limited settings, air-encephalography is the only investigative modality that allows differentiation.