OBJECTIVE

The aim of this study was to compare the outcomes of the shunted and non shunted group of children with tuberculous meningitis hydrocephalus. Another objective is to determine the applicability of the Palur classification and treatment algorithm in managing Filipino children with TBM hydrocephalus.

METHODS

Forty nine children that satisfied the criteria for a probable TB meningitis with hydrocephalus in a tertiary hospital were reviewed. Frequency statistics, Chi square and Fischer Exact Test were used
to describe the data collected.

RESULTS

There were 24 males and 25 were female chi ldren. The average age on admission was 9 months. Thirty-one patients were managed medically and eighteen underwent neurosurgical intervention. Of the 31 medically managed, 26 were on stage II and 5 were on stage Ill. Eighty percent of these
medically managed patients survived and six children died. There were 8 children who underwent serial lumbar tap in combination with acetazolamide. Eighty seven per cent of these patients improved as compared to 78% among those on oral acetazolamide alone. Of the 18 children managed surgically, 7 were on stage II and 11 were in stage Ill. Eighty eight percent of these shunted patients survived and 2 children did not improve. Outright VP shunting showed more improvement compared to TV prior to VPS. Early or delayed timing in shunting did not affect outcome on discharge.

CONCLUSION

Medical management still plays a role in treating stage II patients using the BMRC classification and a much higher percentage of survival was noted among patients falling under grade II TBM according to Palur grading. Despite the clarity of the protocol recommended by Palur, treatment and classification should be individualized and based on the local experience of each setting.

Human ; Hydrocephalus

OBJECTIVE

The aim of this study was to compare the outcomes of the shunted and non shunted group of children with tuberculous meningitis hydrocephalus. Another objective is to determine the applicability of the Palur classification and treatment algorithm in managing Filipino children with TBM hydrocephalus.

METHODS

Forty nine children that satisfied the criteria for a probable TB meningitis with hydrocephalus in a tertiary hospital were reviewed. Frequency statistics, Chi square and Fischer Exact Test were used
to describe the data collected.

RESULTS

There were 24 males and 25 were female chi ldren. The average age on admission was 9 months. Thirty-one patients were managed medically and eighteen underwent neurosurgical intervention. Of the 31 medically managed, 26 were on stage II and 5 were on stage Ill. Eighty percent of these
medically managed patients survived and six children died. There were 8 children who underwent serial lumbar tap in combination with acetazolamide. Eighty seven per cent of these patients improved as compared to 78% among those on oral acetazolamide alone. Of the 18 children managed surgically, 7 were on stage II and 11 were in stage Ill. Eighty eight percent of these shunted patients survived and 2 children did not improve. Outright VP shunting showed more improvement compared to TV prior to VPS. Early or delayed timing in shunting did not affect outcome on discharge.

CONCLUSION

Medical management still plays a role in treating stage II patients using the BMRC classification and a much higher percentage of survival was noted among patients falling under grade II TBM according to Palur grading. Despite the clarity of the protocol recommended by Palur, treatment and classification should be individualized and based on the local experience of each setting.

Human ; Hydrocephalus