Isotopic cisternography in tuberculous meningitis of childhood

The changes in the CSF circulation and absorption are valuable in the diagnosis and management of tuberculous meningitis. We describe the isotopic cisternographic analysis of 45 children with tuberculous meningitis and 30 children with purulent meningitis. The cisternographic patterns of tuberculous meningitis consist of (1) obliteration of CSF space at the level of basal cisterns or cisterna Sylvii and (2) ventricular entry of radiopharmaceutical without clearing by 24 hours (communicating hydrocephalus). None of the patients with a definite diagnosis of tuberculous meningitis demonstrated a normal CSF flow pattern. Thirty patients with purulent meningitis underwent isotopic cisternography. Sixteen of 30 patients demonstrated a normal CSF flow pattern, 3 had mild hydrocephalus, 6 had obliteration of the subarachnoid space at the level of cisterna Sylvii at either side, 3 had delay of CSF flow, and 2 had abnormal CSF collection due to a posttraumatic dura defect.