Introduction

Neurotuberculosis constitutes a significant health care burden in India.

Method

Case records of children (n=78) diagnosed with neurotuberculosis between January 2012 and April 2017 in a tertiary care teaching center in North India were retrospectively reviewed and analyzed for demographic details, clinical presentation, radiological and laboratory parameters, management and outcome (using Pediatric Cerebral Performance Scale-PCPS).

Results

In the 78 cases (7.95+/-2.08 years; 41 boys), predominant symptoms were: vomiting (57%), headache (37%), fever (20%), encephalopathy (19%) and seizures (12%) and signs were: focal deficits (29%; cranial nerve palsy 16%, spasticity 12%, hemiparesis 10% and extrapyramidal features 8%) , Kernig’s sign (14%),  and papilledema (9%).

Analysis of CSF showed:120 cells/mm³ (IQR-42-305 cells/mm³-predominantly lymphocytic), CSF hypoglycorrhachia(mean 35.53+/-16.90% of blood sugar) and protein of 163.43+/-72.76 mg/dl.

Radiologically commonest was TBM (74%; 23% isolated, 47% with tuberculoma,4% with spinal arachnoiditis, 5% with opticochiasmaticarachnoiditis and 6% with vasculitis). Isolated tuberculoma and spinal TB were found in 24.5% and 1.5% respectively.

Median duration of ATT was 12 months(IQR 12-24 months)with an intensive phase of 3 months(IQR- 3-6 months). MDR TB was found in 1% and category 2 ATT was required in 15%. Overall 47% had hydrocephalus of which 19% required CSF diversion procedure.

At treatment completion, 89% children had good final outcome(PCPS1-2) with mortality of 4%.

Conclusion

Clinical suspicion with suggestive radiological findings is the mainstay for establishing diagnosis of Neurotuberculosis. Majority of children have good final outcome on timely initiation of ATT.