Cerebral infarction and neurodevelopmental outcome in childhood tuberculous meningitis

Introduction: Cerebral infarction is an important cause of neurological sequelae in childhood tuberculous meningitis (TBM). Aim: To investigate neurodevelopmental outcome and development of motor sequelae in TBM-related cerebral infarction. Methods: A group of 64 children with TBM and computerized tomographic (CT) evidence of infarction were compared with regard to motor sequelae and neurodevelopmental outcome, with 54 children with TBM but no radiological evidence of infarction. The association between infarct number, size, location and outcome was investigated in the infarct group. Selected covariates were entered into a multivariate model to better understand the independent contribution of each factor on neurodevelopmental outcome. Results: An association was found between the presence, number and size of hemispheric infarcts and motor handicap on follow-up. Location of single basal ganglia infarcts, however, did not correlate with motor outcome. The Griffiths general developmental quotient (GQ) was significantly lower in children with bilateral (p < 0001) and unilateral multiple infarcts (p = 0.0239) compared to those without infarcts. The GQ of children with unilateral single infarcts was not significantly lower than those without infarction (p = 0.2282). Conclusion: Infarct characteristics should be taken into account when neurodevelopmental outcome is prognosticated in TBM. Young age, unilateral multiple or bilateral infarction on CT at 1 month, advanced stage of TBM and the interaction term stage x Glasgow coma score are the best predictors of neurodevelopmental outcome at 6 months. (C) 2008 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.