Complications of tuberculous meningitis and their effect on outcome in a tertiary care cohort

<b>Figure 1</b> Cranial imaging showing various complications of TBM in a 35-year-old male. The patient had fever and headache for 4 months. CSF analysis revealed 105 mg/dl protein, 95 lymphocytic/mm³ and positive Xpert results. He was prescribed four-drug ATT. After 15 days, the patient became drowsy; CT revealed communicating hydrocephalus and thalamic infarction (not shown). <b>A) </b>After ventriculo peritoneal shunt, the patient improved. His MRI 15 days later revealed increased exudate, tuberculoma and cerebral salt wasting. <b>B)</b> Fifteen days later, he needed mechanical ventilation for 2 days and had altered liver functions (serum alanine amino transaminase 118 U/L, bilirubin 1 mg/dl). TBM = tuberculous meningitis; CSF = cerebro-spinal fluid; ATT = anti-tuberculosis treatment; CT = computed tomography; MRI = magnetic resonance imaging.<br><b>Figure 2 </b>Kaplan-Meier graphs show there was significantly longer survival in patients without infarct (<i>P</i> = 0.004), seizure (<i>P</i> = 0.004), hyponatremia (<i>P</i> = 0.018), paradoxical worsening (<i>P</i> = 0.001) and mechanical ventilation (<i>P</i> = 0.001).