Introduction

Tuberculous  meningitis (TBM) can be difficult to diagnose, and delay in treatment can result in death or neurological morbidity. MRI has increased sensitivity in detecting meningeal inflammation and space occupying lesions compared with CT.

Aim

To review whether a combination of symptoms and MRI brain imaging can be predictive in diagnosis of TBM.

Methods

Single centre study including 3 hospitals in East London. Retrospective analysis of patients treated for TBM confirmed with lumbar puncture results suggestive of probable TBM.

Results

20 cases (13 male) diagnosed between 2014-2018 were included. Median age was 37 (IQR 31-43). 4 were Bengali, 3 Black African, 6 Indian, 5 Pakistani and 2 Caucasian. Mean CSF WCC 104/mm3. Mean CSF lymphocyte count 88%. Mean CSF protein count 1523mg/L. Mean CSF glucose count 3.1mmol/L. Median length of illness pre-diagnosis 14 days (IQR 12-120). 25% cases (5/20) had positive CSF culture for Myobacterium Tuberculosis. All cases had an MRI brain. 65% cases (13/20) had MRI features consistent with TBM. Of those cases, 85% (11/13) had symptoms, most commonly headache, nausea and vomiting. Neurological signs were found in 3 patients, including fixed dilated pupil and clonus; diplopia and VI cranial nerve palsy; and lower limb weakness. 3 cases had a normal MRI brain, and 4 had non-specific changes. All 7 cases without typical MRI changes had symptoms suggestive of TBM, most commonly headache, nausea and vomiting. 2 of these cases had unilateral hypoesthesia , 2 had diplopia, and 1 had hemiplegia. Out of all cases, only 3/20 described meningitic symptoms of neck stiffness or photophobia.

Conclusion

Our study emphasizes the importance of performing a MRI brain in suspected TBM.