Single photon emission computed tomography in tuberculous meningitis
U K Misraa, J Kalitaa, B K Dasb
a Sanjay Gandhi
Postgraduate Institute of Medical Sciences, Lucknow 226 014, India:
Department of Neurology, b Department of Nuclear Medicine
Correspondence to: Dr Misra (email: ukmisra{at}sgpgi.ac.in)
Submitted 3 June 1998;
Accepted 13 January 2000
INTRODUCTION
Data on single photon
emission computed tomography (SPECT) in tuberculous meningitis are
lacking and prompted this study. SPECT findings in tuberculous
meningitis are reported and correlated with clinical and radiological findings.
PATIENTS AND METHODSSeventeen
patients with tuberculous meningitis that was diagnosed on clinical,
radiological, and laboratory criteria have been included. Their age
ranged between 5 and 62 years and four of them were female. Computed
tomography and/or magnetic resonance imaging (MRI) and SPECT using
99mTc-ethylene cystine dimer were performed in all the
patients. On the basis of Barthel index (BI) score the patients'
outcome was defined as complete (BI = 20), partial (BI = 19-12), and
poor recovery (BI<12).
RESULTEleven patients were in
stage III and three each in stage II and stage I tuberculous
meningitis. Two patients had hemiplegia and five quadriplegia. Computed
tomography was abnormal in 11 out of 16 patients and revealed
hydrocephalus in nine, basal exudates, infarction in subcortical white
matter and basal ganglia in six patients each, frontal cortical
infarction in one, and granulomata in three patients. Cranial MRI was
carried out in four patients and revealed multiple granulomata,
hydrocephalus, and brainstem infarction in two patients each. SPECT
studies were abnormal in all except two patients and revealed
hypoperfusion of the basal ganglia in 14, cortical hypoperfusion in 10, and midbrain hypoperfusion in one patient. At the three month follow up
four patients had died, five had poor, three partial, and five complete
recovery. The SPECT studies were more frequently abnormal compared with computed tomography but did not correlate with stage of meningitis or outcome.
CONCLUSIONIn tuberculous
meningitis subcortical and cortical hypoperfusion is common but it does
not correlate with stage of meningitis or three month outcome.
Keywords: tuberculous meningitis; single photon emission computed tomography (SPECT); computed tomography; magnetic resonance imaging
© 2000 by The Fellowship of Postgraduate Medicine
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