Open AccessBrain MRI findings in relation to clinical characteristics and outcome of tuberculous meningitis
Author(s) -
Sofiati Dian,
Robby Hermawan,
Arjan van Laarhoven,
Sofia Immaculata,
Tri Hanggono Achmad,
Rovina Ruslami,
Farhan Anwary,
Ristaniah D. Soetikno,
Ahmad Rizal Ganiem,
Reinout van Crevel
Publication year - 2020
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0241974
Subject(s) - medicine , glasgow coma scale , tuberculous meningitis , magnetic resonance imaging , lesion , meningitis , hydrocephalus , prospective cohort study , coma (optics) , pathology , radiology , surgery , physics , optics
Neuroradiological abnormalities in tuberculous meningitis (TBM) are common, but the exact relationship with clinical and inflammatory markers has not been well established. We performed magnetic resonance imaging (MRI) at baseline and after two months treatment to characterise neuroradiological patterns in a prospective cohort of adult TBM patients in Indonesia. We included 48 TBM patients (median age 30, 52% female, 8% HIV-infected), most of whom had grade II (90%), bacteriologically confirmed (71%) disease, without antituberculotic resistance. Most patients had more than one brain lesion (83%); baseline MRIs showed meningeal enhancement (89%), tuberculomas (77%), brain infarction (60%) and hydrocephalus (56%). We also performed an exploratory analysis associating MRI findings to clinical parameters, response to treatment, paradoxical reactions and survival. The presence of multiple brain lesion was associated with a lower Glasgow Coma Scale and more pronounced motor, lung, and CSF abnormalities (p-value <0.05). After two months, 33/37 patients (89%) showed worsening of MRI findings, mostly consisting of new or enlarged tuberculomas. Baseline and follow-up MRI findings and paradoxical responses showed no association with six-month mortality. Severe TBM is characterized by extensive MRI abnormalities at baseline, and frequent radiological worsening during treatment.