Tuberculous meningitis in adults: a prospective study at a tertiary referral centre in Sri Lanka.

INTRODUCTION Central nervous system tuberculosis is the most severe form of extrapulmonary TB and it is associated with a substantial morbidity and mortality. OBJECTIVES To describe the demographic profile, clinical features, laboratory and imaging results of a cohort of adult patients with TBM (Tuberculous meningitis). METHODS This study encompasses a prospective analysis of all adult cases of TBM diagnosed from 1st January 2010 to 31st December 2011 in the Neurology unit 2, National Hospital of Sri Lanka. Consensus case definitions for TBM were used for clinical case classification and patients were given a definite, probable, or possible tuberculous meningitis status accordingly. RESULTS A total of 89 patients fulfilled the established diagnostic criteria for TBM and there were 22 definitive cases, 46 probable cases and 21 possible cases. The mean age of the series was 44 years and 56 (63%) were males. TBM presented with fever in 64 (71%), general constitutional symptoms in 61 (68%), headache in 53 (59%), and diminished level of consciousness in 36 (40%) patients. CSF biochemistry revealed elevated protein in all patients. MRI brain showed meningeal enhancement in 73 (82%). Twenty four (27%) died during hospitalisation and out of 65 who survived 44 (49%) had residual sequelae at the time of discharge. CONCLUSIONS MRI evidence and biochemical analysis of CSF are still the main supportive diagnostic modalities. TBM is a relatively common but difficult to diagnose disease, which results in significant morbidity and mortality.