TY - JOUR
T1 - HHH regime for arteritis secondary to TB meningitis
T2 - A prospective randomized study
AU - Gujjar, Arunodaya R.
AU - Srikanth, S. G.
AU - Umamaheshwara Rao, G. S.
N1 - Funding Information:
Acknowledgments This study was funded by the National Institute of Mental Health and Neurosciences, Bangalore, India. The authors thank the patients and their families; Microbiology and Pathology Departments for diagnostic support; and staff of ICU/Stroke ward. The authors express their thanks to Dr. Deepa for assistance in data collection.
PY - 2009/6
Y1 - 2009/6
N2 - Background: Tuberculous meningitis (TBM) is a fairly common, debilitating disease and is often complicated by arteritis resulting in brain infarction. Few treatment regimes specifically address this condition. Hypervolemia- hypertension-hemodilution (HHH) regime is known to be effective for treatment of vasospasm complicating subarachnoid hemorrhage. We studied the efficacy of HHH regime in patients with TBM with arteritis using a prospective, randomized study design. Patients and Methods: Patients diagnosed to have TB meningitis by clinical, CSF, and imaging findings were evaluated for arteritis, which was recognized by presence of focal neurologic deficits with or without corresponding focal hypodensities on brain CT scan. Patients with deficits of <96 h were randomized to HHH or conservative treatment. All patents received four-first-line anti-TB drugs and Inj.dexamethasone. HHH therapy was administered over 3-9 days. Neurologic status and modified Rankin score were noted serially and at discharge. Results: Seven patients received HHH and 5, conservative treatment. All had hemiparesis with power 0-3/5. Median GCS was worse in HHH group (11 vs. 13). In the HHH group, 6/7 improved in motor power, and 5/7 in sensorium. In the control group, 3/5 improved in motor power and 3/5 in sensorium. Four patients died in each group. Conclusion: HHH therapy is safe and may be beneficial in the management of patients with infective arteritis secondary to TBM. Further study in a larger group with improved monitoring of cerebral circulation is indicated.
AB - Background: Tuberculous meningitis (TBM) is a fairly common, debilitating disease and is often complicated by arteritis resulting in brain infarction. Few treatment regimes specifically address this condition. Hypervolemia- hypertension-hemodilution (HHH) regime is known to be effective for treatment of vasospasm complicating subarachnoid hemorrhage. We studied the efficacy of HHH regime in patients with TBM with arteritis using a prospective, randomized study design. Patients and Methods: Patients diagnosed to have TB meningitis by clinical, CSF, and imaging findings were evaluated for arteritis, which was recognized by presence of focal neurologic deficits with or without corresponding focal hypodensities on brain CT scan. Patients with deficits of <96 h were randomized to HHH or conservative treatment. All patents received four-first-line anti-TB drugs and Inj.dexamethasone. HHH therapy was administered over 3-9 days. Neurologic status and modified Rankin score were noted serially and at discharge. Results: Seven patients received HHH and 5, conservative treatment. All had hemiparesis with power 0-3/5. Median GCS was worse in HHH group (11 vs. 13). In the HHH group, 6/7 improved in motor power, and 5/7 in sensorium. In the control group, 3/5 improved in motor power and 3/5 in sensorium. Four patients died in each group. Conclusion: HHH therapy is safe and may be beneficial in the management of patients with infective arteritis secondary to TBM. Further study in a larger group with improved monitoring of cerebral circulation is indicated.
KW - Arteritis
KW - HHH therapy
KW - Tuberculous meningitis
UR - http://www.scopus.com/inward/record.url?scp=70349254524&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=70349254524&partnerID=8YFLogxK
U2 - 10.1007/s12028-008-9182-8
DO - 10.1007/s12028-008-9182-8
M3 - Article
C2 - 19219569
AN - SCOPUS:70349254524
VL - 10
SP - 313
EP - 317
JO - Neurocritical Care
JF - Neurocritical Care
SN - 1541-6933
IS - 3
ER -