[Ventriculoperitoneal shunt for hydrocephalus secondary to tuberculous meningitis: a case report]

A case of hydrocephalus secondary to tuberculous meningitis is reported. A 6-month-old baby was admitted to our hospital with a 10-day history of high fever. Neurological examination revealed no abnormal findings other than neck stiffness. Cerebrospinal fluid findings suggested tuberculous meningitis, because of pleocytosis (608/mm3, 100% lymphocytes) and reduced sugar content (19 mg/dl). Mycobacterium tuberculosis was found in cerebrospinal fluid culture. Although anti-tuberculous therapy was administered for 2 weeks, deterioration of consciousness and papilledema appeared. CT scan demonstrated enlargement of the entire ventricular system, indicating communicating hydrocephalus. After a ventricular drainage was performed, consciousness disturbance improved, but the high fever persisted. Judging by cerebrospinal fluid findings, the meningitis seemed to be in the active stage. Therefore an Ommaya reservoir was installed instead of a cerebrospinal fluid shunt for fear of disseminating the tuberculous infection through the shunt tube. However, the hydrocephalus was not well controlled. Consequently, a ventriculoperitoneal shunt was placed, despite the fact that the disease was still active. The fever then gradually subsided, and cerebrospinal fluid findings normalized. The patient was discharged without any neurological deficits one month after emplacement of the ventriculoperitoneal shunt. The antituberculous therapy has been continued, and there is no sign of infection propagated through the shunt 13 months following discharge from the hospital. The result suggests that a cerebrospinal fluid shunt can be placed for hydrocephalus even in the active stage of tuberculous meningitis under antituberculous therapy.