| Objective:To explore the clinical material and correlated risk factors influencing short-term prognosis of tuberculous meningitis with hydrocephalus(TBMH)in children.Methods:We make a retrospective analysis of the 87 patients with TBMH who were hospitalized in the Children's Hospital of Chongqing Medical University from January 2011 to December 2016.Results:(1)In all cases of TBMH,including 60% less than 5 years old,24% aged 5 years old to 10 years old,16% more than 10 years old,there were 44% less than 3 years old.64% of them come from the countryside.(2)59%(51/87)had the history of BCG,34%(30/87)are not,the other was unknown.38%(33/87)children had tuberculosis contact history,61%(20/33)in young infants.87%(76/87)complicated with extracranial tuberculosis,all(100%,76/76)complicated with pulmonary tuberculosis.(3)Clinical staging showed that of the 87 children 15%(13/87)were in the early stage,31%(27/87)in the medium stage and 54%(47/87)in the late stage of TBM.A total of 74%(64/87)hydrocephalus manifested itself within 4 weeks following the disease's onset.One to three times repeated cranial CT/MRI were performed when hydrocephalus was diagnosed.(4)Clinical symptoms according to the proportion of occurrence: fever(94%,82/87),high cranial pressure symptoms(86%,75/87),other tuberculosis poisoning symptoms(83%,72/87),altered consciousness(83%,72/87),convulsion(61%,51/87),psychological and behavioral abnormalities(17%,15/87),involuntary movements(13%,13/87),gatism(5%,4/87),aphasia(2%,2/87).Clinical signs according to the proportion of occurrence: positive signs of meningeal irritation(83%,72/87),paralysis(67%,58/87),positive Babinski signs(62%,54/87),cranial nerve palsy(47%,41/87).In the cranial nerve palsy,Facial nerve was the majority(59%,24/41),followed oculomotor nerve(54%,22/87),abducens nerve(15%,6/41),optic nerve(10%,4/41).(5)35%(27/77)had etiological evidence in cerebrospinal fluid(CSF),18% were smear positive for acid fast bacilli,27% were positive for mycobacterium tuberculosis culture.(6)The first biochemical analyses of CSF have the typical changes among 60%(46/77)patients of TBMH.(7)The main radiological changes of TBMH in cranial MRI or CT are the basal ganglia lesion(72% / 33%),brain parenchyma lesion(83% / 29%),cistern and meningeal changes(39% / 5% and24% / 3%).(8)We made a single factor analysis of all the clinic data,clinical stage of TBMH,convulsion,altered consciousness,positive signs of meningeal irritation,positive Babinski signs,paralysis,length of stay in hospital,intrathecal injection and anti-tuberculosis treatment were statistically significant(P < 0.05).Multivariate logistic analysis revealed two main risk factors for a poor short-term prognosis: clinical stage of TBMH(P=0.006,OR=3.888,95%CI 1.486~10.167),altered consciousness(P=0.026,OR =14.238,95%CI 3.827~147.122).And one protective factor: intrathecal injection(P=0.006,OR=0.148,95%CI 0.039~0.572).Conclusions:(1)The TBMH mainly influence children under 5years old,especially under 3 years old.The children with TBMH were mainlv from the rural areas.(2)The prominent manifestations of TBMH are fever,vomiting,convulsion,altered consciousness,positive signs of meningeal irritation,positive Babinski signs,paralysis and cranial nerve palsy.(3)cranial MRI is superior to CT.(4)Extrameningeal tuberculosis presented most frequently as pulmonary tuberculosis,approximately half of young infants had tuberculosis contact history.(5)Most of TBMH were in the medium and late stage,hydrocephalus in TBMH is most within 4 weeks following the disease's onset.(6)clinical late stage,convulsion,altered consciousness,positive signs of meningeal irritation,positive Babinski signs and paralysis were closely related to poor prognosis.Increased length of stay in hospital,intrathecal injection and anti-tuberculosis treatment were effective in improving prognosis.clinical stage of TBMH and altered consciousness are risk factors for a poor short-term prognosis,intrathecal injection is protective factor for a poor short-term prognosis. |
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