Comparing clinical and radiological findings of patients with the urodynamic study outcome in patients with tuberculous meningitis
Dr. Arvind Gupta, Dr. RK Garg, Dr. Sandhya Gupta
Background: Central nervous system (CNS) involvement is one of the most devastating clinical manifestations of tuberculosis (TB), which is noted in 5 to 10% of extrapulmonary TB case. Definitive diagnosis of tuberculous meningitis (TBM) is important to decrease the morbidity and mortality associated with it. Aims and Objectives: To study and compare clinical and radiological findings with the urodynamic study findings in TBM patients. Materials and Methods: Fifty one TBM patients were studied in Neurology Department of KGM Medical University, Lucknow. Patients were categorized based on GCS, BMRC staging, Modified Barthel Index, X ray findings and MRI brain imaging and compared with the urodynamic study outcome (normal or abnormal). Results: A significant association was observed between GCS Score, BMRC Stage III and Baseline Modified Barthel Index and abnormal Urodynamic study. No statistically significant association was observed between diagnostic category and chest X-ray findings and abnormal Urodynamic study. MRI brain showed significant relationship of meningeal enhancement, hydrocephalus, basal exudates, and infarcts with abnormal urodynamic study. Maximum patients with poor outcome belonged to BMRC III (p=0.016) and those having low GCS value (GCS<14) (p<0.05). No statistically significant association was observed between diagnostic category of TBM and final outcome (p=0.205). Hydrocephalous, basal exudates and tubercular infarct were the CT findings which affected the outcome of patients significantly (p<0.05). Conclusion: GCS Score, BMRC Stage III and Baseline Modified Barthel Index had significant association with abnormal urodynamic study. Meningeal enhancement, hydrocephalus, basal exudates, and infarcts were significantly associated with abnormal urodynamic study. BMRC stage III and low GSC value were the significant predictors for poor outcome.