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Serial MRI todetermine the effectof dexamethasone onthe cerebralpathology oftuberculousmeningitis: anobservational study Guy ThwaitesJeremy Macmullen‐PriceTran Thi Hong Chau2007 год

Serial MRI to determine the effect of dexamethasone on the cerebral pathology of tuberculous meningitis: an observational study
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Аннотация: BackgroundAdjunctive dexamethasone increases survival from tuberculous meningitis, but the underlying mechanism is unclear. We aimed to determine the effect of dexamethasone on cerebral MRI changes and their association with intracerebral inflammatory responses and clinical outcome in adults treated for tuberculous meningitis.MethodsCerebral MRI was undertaken, when possible, at diagnosis and after 60 days and 270 days of treatment in adults with tuberculous meningitis admitted to two hospitals in Vietnam. Patients were randomly assigned either dexamethasone (n=24) or placebo (n=19) and received 9 months of treatment with standard first-line antituberculosis drugs. We assessed associations between MRI findings, treatment allocation, and resolution of fever, coma, cerebrospinal fluid inflammation, and neurological outcome.Findings83 scans were done for 43 patients: 19 given placebo, 24 given dexamethasone. Basal meningeal enhancement (82%) and hydrocephalus (77%) were the most common presenting findings. Fewer patients had hydrocephalus after 60 days of treatment with dexamethasone than after placebo treatment (p=0·217). Tuberculomas developed in 74% of patients during treatment and in equal proportions in the treatment groups; they were associated with long-term fever, but not relapse or poor clinical outcome. The basal ganglia were the most common site of infarction; the proportion with infarction after 60 days was halved in the dexamethasone group (27% vs 58%, p=0·130).InterpretationDexamethasone may affect outcome from tuberculous meningitis by reducing hydrocephalus and preventing infarction. The effect may have been under-estimated because the most severe patients could not be scanned.
Год издания: 2007
Авторы: Guy Thwaites, Jeremy Macmullen‐Price, Tran Thi Hong Chau, Pham Phuong, Thị Dung Nguyễn, Cameron P. Simmons, Nicholas J. White, Tran Tinh Hien, David Summers, Jeremy Farrar
Издательство: Elsevier BV
Источник: The Lancet Neurology
Ключевые слова: Infectious Diseases and Tuberculosis, Bacterial Infections and Vaccines, Infectious Encephalopathies and Encephalitis
Другие ссылки: The Lancet Neurology (PDF)
The Lancet Neurology (HTML)
Europe PMC (PubMed Central) (PDF)
Europe PMC (PubMed Central) (HTML)
PubMed Central (HTML)
Oxford University Research Archive (ORA) (University of Oxford) (PDF)
Oxford University Research Archive (ORA) (University of Oxford) (HTML)
PubMed (HTML)