Distribution of brain infarction in children with tuberculous meningitis and correlation with outcome score at 6 months

Background: Prognostic indicators for tuberculous meningitis (TBM) offer realistic expectations for parents of affected children. Infarctions affecting the basal ganglia are associated with a poor outcome. Objective: To correlate the distribution of infarction in children with TBM on CT with an outcome score ( OS). Materials and methods: CT brain scans in children with TBM were retrospectively reviewed and the distribution of infarctions recorded. The degree of correlation with OS at 6 months was determined. Results: There was a statistically significant association between all sites of infarction (P = 0.0001 - 0.001), other than hemispheric (P = 0.35), and outcome score. There was also a statistically significant association between all types of infarction (P = 0.0001 - 0.02), other than hemispheric (P = 0.05), and overall poor outcome. The odds ratio for poor outcome with bilateral basal ganglia and internal capsule infarction was 12. The odds ratio for poor outcome with 'any infarction' was 4.91 (CI 2.24 - 10.74), with 'bilateral infarctions' 8.50 ( CI 2.49 - 28.59), with basal ganglia infarction 5.73 ( CI 2.60 - 12.64), and for hemispheric infarction 2.30 ( CI 1.00 - 5.28). Conclusion: Infarction is associated with a poor outcome unless purely hemispheric. MRI diffusion-weighted imaging was not part of this study, but is likely to play a central role in detecting infarctions not demonstrated by CT.