CSF protein concentration associated with ventriculoperitoneal shunt obstruction in tuberculous meningitis

INTRODUCTION: Hydrocephalus occurs in 85% of patients with tuberculous meningitis (TBM). Ventriculoperitoneal shunt (VPS) insertion is first-line treatment for relieving increased intercranial pressure. VPS obstruction secondary to increased protein levels in cerebrospinal fluid (CSF) is a known com...

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Bibliographic Details
Published in:The international journal of tuberculosis and lung disease 2018-07, Vol.22 (7), p.788-792
Main Authors: Kamat, A. S., Gretschel, A., Vlok, A. J., Solomons, R.
Format: Article
Language:English
Subjects:
Adults
Cerebrospinal fluid
Children
Correlation analysis
Csf Protein
Hydrocephalus
Insertion
Kinases
Meningitis
Obstruction
Patients
Proteins
Statistical analysis
Statistical methods
Tuberculosis
Tuberculous Meningitis
Ventricle
Ventriculoperitoneal shunt
Vps
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Summary:INTRODUCTION: Hydrocephalus occurs in 85% of patients with tuberculous meningitis (TBM). Ventriculoperitoneal shunt (VPS) insertion is first-line treatment for relieving increased intercranial pressure. VPS obstruction secondary to increased protein levels in cerebrospinal fluid (CSF) is a known complication.OBJECTIVE: To ascertain if there is a difference in protein levels 1) between cranial and lumbar CSF, and to quantify levels associated with VPS obstruction, and 2) obtained from lumbar puncture vs. ventricular CSF.METHOD: A 30-year retrospective analysis was undertaken. CSF protein levels were statistically analysed to determine correlation between these levels and VPS obstruction.RESULTS: Of 214 children and 376 adults who underwent VPS insertion for TBM, respectively 27.5% and 25.5% sustained blocked VPS. The mean protein level in CSF collected from the non-obstructed group was 1.76 g/l, compared to 2.94 g/l in the obstructed group. The mean CSF protein level from intraoperative ventricular vs. lumbar puncture samples in the VPS obstruction group was respectively 2.471 g/l and 2.474 g/l.CONCLUSION: Patients with increased protein levels in CSF are at a high risk of VPS blockage. In these patients, temporary measures should be employed until CSF protein levels decrease.
ISSN:1027-3719
1815-7920
DOI:10.5588/ijtld.17.0008