Neuroradiology in Tuberculous Meningitis- Diagnostic Significance and Prognostic Value

Introduction:Tuberculous meningitis (TBM) is the most common and belligerent form of CNS TB.Prompt definitive diagnosis of TBM is arduous due to tedious microbiological procedures. This study was conducted to evaluate the neuroradiological findings in patients with TBM as a modality forearly diagnoses and predicting prognosis. Materials and methods: A successive series of 100 patients diagnosed with TBM admitted to the PIMS neurology ward were studied between March 2013 and April 2014. Cranial imaging results were obtained by non-contrast enhanced CT brain (NECT) and MRI (magnetic resonance imaging) brain with contrast. MRC staging on admission and in-hospital mortality were recorded.Results: The mean age was 34.86 ± 1.76 years with a female preponderance (55%, 55 out of 100). On admission, 72% were in MRC stages II or III. The in-hospital mortality was 16%. NECT was obtained in all the patients and was abnormal in 67% of the patients with hydrocephalus (58%), edema cerebral (24%) and infarcts (5%) being the commonestfindings.CT infarct had the highest mortality rate of 60%. MRI was obtained in 61% of the patients and was abnormal in 88.5% of these cases. Hydrocephalus (61%), tuberculomas (54%), leptomeningeal involvement (46%) and infarcts (13%) were the most frequent radiological signs on MRI. Mortality was significantly associated with infarcts but not with tuberculomas.Conclusion: Neuroimaging techniques are a handy tool in the early diagnosis of TBM. MRI is particularly helpful in defining findings such as infarcts and tuberculomas and in predicting mortality and morbidity.