Value of early follow-up CT in paediatric tuberculous meningitis

• Published in: Pediatric radiology 2005-11, Vol.35 (11), p.1092-1099
• Main Authors: Andronikou, Savvas, Wieselthaler, Nicky, Smith, Bruce, Douis, Hassan, Fieggen, A Graham, van Toorn, Ronald, Wilmshurst, Jo
• Format: Article
• Language: English
• Subjects: Adolescent; Cerebral Infarction - diagnostic imaging; Cerebral Infarction - etiology; Cerebral Infarction - prevention & control; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Hydrocephalus - diagnostic imaging; Hydrocephalus - etiology; Hydrocephalus - prevention & control; Infant; Male; Prognosis; Radiography; Reproducibility of Results; Retrospective Studies; Risk Assessment - methods; Risk Factors; Sensitivity and Specificity; Tuberculosis, Meningeal - complications; Tuberculosis, Meningeal - diagnostic imaging; Tuberculosis, Meningeal - therapy
• ISSN: 0301-0449; 1432-1998
• DOI: 10.1007/s00247-005-1549-9

The value of CT in the diagnosis of tuberculous meningitis (TBM) in children is well reported. Follow-up CT scanning for these patients is, however, not well described and, in particular, the value of early follow-up CT has not been addressed for children with TBM. To assess the value of early follow-up CT in children with TBM in identifying diagnostic, prognostic and therapeutically relevant features of TBM. A retrospective 4-year review of CT scans performed within 1 week and 1 month of initial CT in children with proven (CSF culture-positive) and probable TBM (CSF profile-positive but culture-negative) and comparison with initial CT for the diagnostic, prognostic and therapeutic CT features of TBM. The CT scans of 50 children were included (19 "definite" TBM; 31 "probable" TBM). Of these, 30 had CT scans performed within 1 week of the initial CT. On initial CT, 44 patients had basal enhancement. Only 24 patients had contrast medium-enhanced follow-up scans. Important findings include: 8 of 29 patients (who were not shunted) developed new hydrocephalus. New infarcts developed in 24 patients; 45% of those who did not have infarction initially developed new infarcts. Three of the six patients who did not show basal enhancement on initial scans developed this on the follow-up scans, while in seven patients with pre-existing basal enhancement this became more pronounced. Two patients developed hyperdensity in the cisterns on non-contrast medium scans. Eight patients developed a diagnostic triad of features. Three patients developed CT features of TBM where there was none on the initial scans. Early follow-up CT is useful in making a diagnosis of TBM by demonstrating features that were not present initially and by demonstrating more sensitive, obvious or additional features of TBM. In addition, follow-up CT is valuable as a prognostic indicator as it demonstrates additional infarcts which may have developed or become more visible since the initial study. Lastly, follow-up CT has therapeutic value in demonstrating hydrocephalus, which may develop over time and may require drainage. We advise routine follow-up CT in patients with suspected TBM within the first week of initial CT and optionally at 1 month.