Tuberculous meningitis with hydrocephalus: A retrospective case series in a UK hospital

Background: Patients may show signs of ventricular enlargement in the early stages of tuberculous meningitis (TBM), and the presence of hydrocephalus is a poor prognostic marker. There is limited evidence on the features which may suggest development of hydrocephalus in TBM (TBMH). 

Methods: We studied hydrocephalus in adult patients with TBM requiring admission at a hospital in the UK between 2019 and 2024. Logistic regression was used to evaluate associations with poor outcome at 6-month follow up. 

Results: 11 of 20 (55.0%) patients developed TBMH. Among these, six (54.5%) had TBMH on the day of admission, whilst five (45.5%) patients developed TBMH following admission. Patients with TBMH on admission had lower Glasgow Coma Scale (GCS) scores on admission (10 vs 15, p < 0.05). Patients who developed TBMH after admission had higher protein levels in their CSF on admission (3 vs 1.4 g/dl, p < 0.05). Of patients with poor Glasgow outcome scale (GOS) scores at 6-month follow up, six (75%) had TBMH. 

Conclusion: Abnormal GCS on admission was strongly associated with TBMH. Patients with no evidence of hydrocephalus on admission may subsequently develop TBMH and a high CSF protein count on admission may predict risk of hydrocephalus development. Early identification of patients at greatest risk of hydrocephalus may help improve outcomes.