Clinical relevance of hydrocephalus as a presenting feature of tuberculous meningitis

Background: Hydrocephalus is a common complication of tuberculous meningitis (TBM). Aim: To study the incidence, associated clinical features, and impact on outcome of hydrocephalus at presentation in TBM. Design: Observational study. Setting: Regional hospital serving 500 000 people. Methods: Adult patients with TBM were studied over 57 months. Those with hydrocephalus on initial CT scan were assessed by neurosurgeons. Clinical, neuroradiological, and biochemical features of patients with hydrocephalus upon presentation were compared to those without initial hydrocephalus. Results: Of 31 TBM patients during the study period, nine (29.0%) had hydrocephalus at presentation, and eight of them (25.8% of all) underwent urgent neurosurgical intervention. Of the 22 patients without initial hydrocephalus, hydrocephalus developed after commencement of chemotherapy in one patient only. Hydrocephalus at presentation was associated with a longer duration of presenting symptoms (p = 0.01), ataxia (p = 0.001), later stages of TBM (p = 0.045), a longer delay before commencement of anti-tuberculous chemotherapy (p = 0.001), stroke (p = 0.012), and a poor outcome at 1 year (p = 0.001). Discussion: Hydrocephalus upon presentation is common in our TBM patients. This may be a poor prognostic marker associated with severe TBM and a higher risk of stroke.