Wednesday 4 January 2012

Hydrocephalus in Tubercular meningitis

A 22 y o female, known case of tubercular meningitis readmitted to casualty with recent onset headache.
On admission non contrast CT:
This CT study shows diffuse cerebral cortical atrophy – mild but significant for age.

A follow up CT after 1wk:
This CT study shows mild communicating hydrocephalus as a complication of Tubercular Meningitis.

CNS Tuberculosis
Involvement of the CNS is seen in ~y 5% of patients with tuberculosis.
Prevalence is greater in immunocompromised patients.
Tuberculous meningitis is the most common manifestation of CNS tuberculosis.
Communicating hydrocephalus is the most common complication of tuberculous meningitis, often caused by blockage of the basal cisterns by inflammatory exudates. Occasionally, non-communicating hydrocephalus occurs due to the mass effect of a tuberculoma causing the obstruction of CSF flow or ependymal adhesion, the commonest site of obstruction is aqueduct.

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