Serial lumbar CSF pressure measurements and cranial computed tomographic findings in childhood tuberculous meningitis

Date
2000
Authors
Schoeman J.F.
Laubscher J.A.
Donald P.R.
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Intracranial pressure (ICP) was monitored in 218 consecutive children with hydrocephalus secondary to tuberculous meningitis (TBM). All children underwent cranial computerized tomographic (CT) scanning and continuous lumbar cerebrospinal (CSF) pressure monitoring on admission. Noncommunicating hydrocephalus (37 children), as determined by air encephalography, was treated by ventriculoperitoneal (VP) shunting and communicating hydrocephalus (181 children), by means of daily acetazolamide and frusemide. Response of ICP to treatment in the group with communicating hydrocephalus was assessed by means of repeated CSF pressure monitoring and CT scanning. One hundred and eighty-five of the 218 patients survived the 1st month of treatment. The aim of this study was the retrospective determination of (1) the relationship between ICP measurements and CT findings on admission and (2) the characteristics of the ICP recording which correlated best with the CT criteria of compensated hydrocephalus after the 1st month of treatment. No relationship was found between the level of baseline CSF pressure and the degree of hydrocephalus, as demonstrated by CT scanning, on admission. Seventy-five per cent of the patients with communicating hydrocephalus that survived the 1st month of treatment complied with the CT criteria for compensated hydrocephalus. All these patients had a baseline CSF pressure below 15 mmHg and absence of high-amplitude B waves on the pressure recording done at the end of the 1st month. In this study repeated lumbar CSF pressure monitoring proved to be an effective instrument to assess the response of communicating tuberculous hydrocephalus to medical treatment and also accurately predicted the timing of compensation of the hydrocephalus.
Description
Keywords
acetazolamide, ethionamide, furosemide, isoniazid, prednisone, pyrazinamide, rifampicin, tuberculostatic agent, article, brain radiography, brain ventricle peritoneum shunt, cerebrospinal fluid pressure, child, communicating hydrocephalus, computer assisted tomography, diagnostic value, human, hydrocephalus, intracranial hypertension, intracranial pressure, major clinical study, Mycobacterium tuberculosis, pneumoencephalography, priority journal, treatment outcome, tuberculous meningitis, Acetazolamide, Antitubercular Agents, Cerebrospinal Fluid Pressure, Child, Combined Modality Therapy, Drug Therapy, Combination, Furosemide, Humans, Hydrocephalus, Intracranial Pressure, Prednisone, Prospective Studies, Retrospective Studies, Survival Rate, Tomography, X-Ray Computed, Tuberculosis, Meningeal, Ventriculoperitoneal Shunt
Citation
Child's Nervous System
16
4