Complications of Tuberculous Meningitis
Acute Neurological Complications Requiring Immediate Recognition
- Hydrocephalus occurs in 42-80% of TB meningitis patients and is the single most important surgically treatable complication, according to the Infectious Diseases Society of America 1
- Neurosurgical referral is mandatory for hydrocephalus, tuberculous cerebral abscess, or paraparesis, as recommended by the Infectious Diseases Society of America 1, 2
- For obstructive hydrocephalus, placement of an external ventricular drain is indicated, as suggested by the Infectious Diseases Society of America 1
Imaging and Monitoring Requirements
- MRI is preferred over CT for superior resolution when intracranial complications are suspected, according to the Infectious Diseases Society of America 1
- Obtain imaging for neurological deterioration, focal deficits, or decreased mental status, as recommended by the Infectious Diseases Society of America 1
Critical Management Principles to Prevent Complications
- Dexamethasone or prednisolone tapered over 6-8 weeks reduces mortality (strong recommendation, moderate certainty), as recommended by the Infectious Diseases Society of America 1, 2
- Extended treatment for 9-12 months total is required (2 months intensive phase followed by 7-10 months continuation), according to the Infectious Diseases Society of America 1