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Transcranial Doppler ultrasonography in hydrocephalic children with tuberculous meningitis
S S Nadvi1, J R Van Dellen, E Gouws
1Department of Neurosurgery, University of Natal, South Africa.
Insights
Congenital hydrocephalus (CH) shows a significant pulsatility index (PI) drop after surgery, unlike hydrocephalus from tuberculous meningitis (TBM). TBM cases with infarcts had minimal PI changes, indicating different pathophysiological responses.
Area of Science:
- Pediatric Neurology
- Neuroimaging
- Infectious Diseases
Background:
- Congenital hydrocephalus (CH) correlates with Gosling pulsatility index (PI) on transcranial Doppler ultrasonography (TCD).
- Hydrocephalus from tuberculous meningitis (TBM), especially with arteritis, lacks similar PI studies.
- TCD is a non-invasive tool for assessing cerebral blood flow dynamics.
Purpose of the Study:
- To compare PI changes after cerebrospinal fluid (CSF) diversion in children with CH versus TBM-induced hydrocephalus.
- To investigate the impact of cerebral infarcts on PI in TBM hydrocephalus.
- To determine if the PI fall observed in CH is also seen in TBM.
Main Methods:
- Prospective TCD examination of 15 children with CH, 15 with TBM hydrocephalus, and 15 controls before and after CSF diversion.
- Comparison of mean PI fall post-surgery between groups.
- CT scans to identify cerebral infarcts in TBM patients.
Main Results:
- A significant PI fall (0.723) occurred in the CH group post-surgery.
- A minimal PI fall (0.089) was observed in the TBM group (p=0.0001).
- TBM patients with infarcts showed significantly different postoperative PI (0.014) compared to those without (0.24).
Conclusions:
- The expected PI fall after CSF diversion in CH is not consistently observed in TBM hydrocephalus.
- Cerebral infarcts in TBM complicate PI dynamics, suggesting distinct underlying pathologies.
- TCD PI response differentiates CH from TBM hydrocephalus, particularly when infarcts are present.
Abstract:
Studies have shown a close correlation between congenital hydrocephalus (CH) and the Gosling pulsatility index (PI) determined by transcranial Doppler ultrasonography (TCD). There have not previously been similar studies in children with hydrocephalus from tuberculous meningitis (TBM), and in particular where arteritis is a prominent feature. Fifteen children from each of these two groups were prospectively examined by TCD before and after CSF diversion. Fifteen children without hydrocephalus were similarly evaluated as controls. The fall in PI following surgery was compared. The mean fall in PI in the congenital hydrocephalic group was 0.723 (SD, 0.42) as compared with 0.089 (SD, 0.16) in the TBM group (p = 0.0001). Ten of the 15 children in the TBM group had infarcts revealed by CT. In these, the PI significantly postoperatively (p = 0.004), (0.014; SD, 0.12) when compared with values obtained (0.24; SD, 0.11) in five children without infarcts. These findings indicate that the clinically relevant fall in PI following CSF diversion in children with congenital hydrocephalus does not necessarily occur in children with hydrocephalus secondary to TBM, especially when complicated by cerebral infarcts.