ASSOCIATION BETWEEN CLINICAL SEVERITY, NEUROIMAGING FINDINGS, AND NEUROLOGICAL RECOVERY IN PATIENTS WITH TUBERCULOUS MENINGITIS

Abstract

Objective: The aim was to check the correlation between clinical severity, the neuroimaging appearance, and neurological improvement, and to determine the important prognostic factors affecting the outcome in patients with tuberculous meningitis.

Methods: An observational study was carried out at Lady Reading Hospital Peshawar from 23 November, 2024 to 23 April, 2025. Through consecutive sampling 245 patients were included who have been diagnosed with tuberculous meningitis. Neurological examination and Glasgow Coma Scale (GCS) were used to assess clinical severity. Computed tomography (CT) and magnetic resonance imaging (MRI) were used for neuroimaging. A complete recovery or a poor outcome were classified as neurological recovery. The data were analyzed with a statistical software and the chi square test and logistic regression were used to look for associations and predictors.

Results: Out of 245 patients the majority presented with moderate to severe clinical disease. Basal meningeal enhancement hydrocephalus and cerebral infarction were the most common imaging findings. There was a significant relationship between the clinical severity and the extensive radiological abnormalities, p < 0.001. In most of patients with severe disease, there was poor neurological recovery. Hydrocephalus and cerebral infarction were the only independent predictors of poor outcome on regression analysis.

Conclusions: The severity of clinical symptoms and the neuroimaging signs were closely associated with neurological recovery in TB meningitis. Prognostic assessment of both parameters at the beginning was helpful in determining management decisions and was more accurate.