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Intracranial pressure monitoring in tuberculous meningitis: clinical and computerized tomographic correlation
Insights
Monitoring cerebrospinal fluid (CSF) pressure in children with tuberculous meningitis revealed that clinical signs of raised intracranial pressure (ICP) are unreliable. ICP monitoring is crucial for accurate diagnosis and management of this condition.
Area of Science:
- Pediatrics
- Neurology
- Infectious Diseases
Background:
- Tuberculous meningitis (TBM) is a serious infection affecting children.
- Raised intracranial pressure (ICP) is a common and dangerous complication of TBM.
- Accurate assessment of ICP is vital for effective management.
Purpose of the Study:
- To evaluate the reliability of clinical signs in diagnosing raised ICP in children with TBM.
- To assess the utility of ICP monitoring in managing TBM.
- To investigate the relationship between hydrocephalus and ICP in TBM.
Main Methods:
- Cerebrospinal fluid (CSF) pressure was monitored in 24 children with acute tuberculous meningitis.
- Clinical signs of raised ICP were correlated with monitored CSF pressure.
- Computerized tomographic (CT) scans were used to assess for hydrocephalus.
Main Results:
- 19 out of 24 children exhibited raised ICP.
- Clinical diagnosis of raised ICP was found to be unreliable, particularly in children with a closed anterior fontanelle.
- All children with raised ICP had hydrocephalus, but the degree of hydrocephalus did not correlate with the degree of ICP.
Conclusions:
- Clinical assessment of raised ICP in pediatric tuberculous meningitis is unreliable.
- Intracranial pressure monitoring is essential for accurate diagnosis and management of raised ICP in TBM.
- Hydrocephalus is consistently present with raised ICP in TBM, but its severity is not directly proportional to ICP levels.
Abstract:
Cerebrospinal fluid (CSF) pressure was monitored in 24 children with acute tuberculous meningitis. 19 had raised intracranial pressure (ICP) as reflected by increased baseline pressure, pressure waves (e.g. B-waves) and increased amplitude of the pulse wave. Correlation between clinical signs of raised ICP and monitored CSF pressure showed that clinical diagnosis of the presence and degree of raised ICP is unreliable, especially in children with a closed anterior fontanelle. Computerized tomographic (CT) scans showed that hydrocephalus was present in all children with raised CSF pressure. No direct correlation was found between the degree of hydrocephalus and the degree of raised ICP. The rôle of ICP monitoring in the diagnosis and management of raised ICP in children with tuberculous meningitis is discussed.