CLINICAL CHARACTERISTIC, NEUROIMAGING AND NEUROLOGICAL OUTCOME OF TUBERCULOUS MENINGITIS IN PEDIATRIC AGE GROUPAT TERTIARY CARE CENTER OF HAPUR ; “A PROSPECTIVE OBSERVATIONAL STUDY”

Abstract

Background: Early diagnosis and treatment is important in reducing mortality and morbidity. The aim of the study was to describe clinical characteristic, neuroimaging and neurological outcome of TBM in pediatric age group. Methods: A total of 72 patients were included in the study based on inclusion and exclusion criteria. Detailed history and neurological examination, CSF analysis, EEG and CT scan studies done in all patients. Mean age of patient was 59 months (range 6month- 18 year). The majority of these patients were in stage II and III. Results: Among 72 patients included in the study tuberculous meningitis was common in children under 5 years of age (70%). Out of 72 patients 50 patients (70%) were in advanced stage of disease. Most common symptom were fever (90%), altered sensorium (83%), convulsion (80%), th vomiting (75%).7 nerve palsy was most commonly involved (25%), hemiplegia in 15 patients (21%) and papilledema in (14%). CSF culture was positive in 61 patients (85%) with Pleocytosis, lymphocytosis and elevated CSF protein as dominant ndings. Abnormal chest X ray present in 11 patients (50%) in stage I, 9 patients (38) in stage II, and 6 patients (23%) in stage III of disease.: In our study Leptomeningeal enhancement was present in 17 patients (77.27%) in stage I, 16 patients (66.6%) in stage II, 18 patients (69.2%) in stage III of disease. Hydrocephalus was presents in 14 patients (63.63%) in stage I, 15 patients (62.5%) in stage II, 17 patients (65.38%) in stage III of disease. Survival with neurological decit is more in younger age and advanced stage of disease. Conclusion: TBM is an important cause of mortality and morbidity in pediatric patients especially under 5 years of age in countries where tuberculosis is an endemic disease. In our study we found younger the child and more advanced the stage of disease, higher CSF protein value, the greater was mortality and morbidity.