All issues > Volume 31(7); 1988

Original Article

J Korean Pediatr Soc. 1988;31(7):892-900. Published online July 31, 1988.

Clinical Review of Tuberculous Meningitis in Children.

Hyung Kook Kim¹, Mi Aie Han¹, Jong Wan Kim¹, Chang Kyu Oh¹, Mahn Kyoo Yang¹

¹Department of Pediatrics, Catholic University Medical College, Seoul, Korea

Received: July 31, 1987;  Accepted: February 1, 1988.

Abstract

147 Cases of tuberculous meningitis who were admitted to the pediatric department of St. PauFs Hospital, Catholic University Medical College from Jan. 1972 to Dec. 1985 were reviewed clinically. The results were as follows 1) The sex ratio, male to female was 1.2:1 2) The age incidence was highest under the age of 1 and 84.4% of the petients were under the age of 6 years. 3) The seasonal incidence in spring, winter and summer was slightly higher than in fall. 4) There was tuberculous patient in the family in 25.2% of all cases and the cases who have tuberculosis in both parents were 19.7% of all cases. 5) The symptoms on admission were in the order vomiting, fever, convulsion, impaired conscious- ness and headache. 6) In the neurological exaination on admission, 51.7% of all cases were in coma or semicomatose state, Kemig or Brudzinski sign was positive in 34.7% of cases, neck stiffness was present in 68.03% of cases and knee jerk was increased in 37.4% of all cases, decreased in 20.4% of cases. 7) The tuberculin skin test was positive in 44.5% of cases. 8) On chest X-ray, tuberculous lesion was seen in 49.0% of all cases and 13% of all cases had X-ray evidence of miliary tuberculosis. 9) In cerebrospinal fluid study, the mean leukocyte count was 315/mm3and the count between 50 and 200/mm3 had the highest incidence of 40.8% of cases. Mean protein level in cerebrospinal fluid was 180 mg/dl and 95.2% of all cases were over 50 mg/dl. Sugar level in cerebrospinal fluid was decreased below 40 mg/dl in the 59.9% of all cases and the mean value was 38 mg/dl. Mean chloride level in cerebrospinal fluid was 113 mEq/1 and 55.7% of all cases was over 110 mEq/1. 10) Overall mortality was 7.5%. 11) The relationship between the factors listed above and the prognosis of tuberculous meningitis in children was as follows i) As the stage of the disease advanced, prognosis was poorer. ii) The prognosis was poor in the cases with the evidence of tuberculosis on chest roentgenogram. iii) The prognosis was poor in the cases with low sugar level and/or high protein level and high differential count of lymphocyte in cerebrospinal fluid. iv) The mortality rate was lower in the group treated with corticosteroids.

Keywords :Tuberculous meningitis