Neurotuberculosis among Filipino children: an 11 years experience at the Philippine Children's Medical Center

Tuberculous meningitis (TBM) remains the most common form of neurotuberculosis in children. Four hundred and five cases of tuberculous meningitis (ages 3–156 months) seen at the Philippine Children's Medical Center (PCMC) from 1987 to 1998 were reviewed. Inclusion criteria include clinical and laboratory profile of TBM with pertinent evidence on imaging such as computed tomography and/or cranial sonography or histologic evidence of TBM. Nearly half of the cases were below age 2. The most common neurologic findings were altered sensorium, neck rigidity, motor and cranial deficits. The mortality rate was 16%. The neuropathologic findings in 31 autopsied cases were basal exudates in 100%, hydrocephalus in 71%, caseation necrosis in 68%, and 35% with infarcts. The most important determinant of outcome is the stage of illness at which the diagnosis is made and appropriate treatment is given. Although computed tomography was more definitive, cranial sonography was a very useful diagnostic tool considering the frequent occurrence below age 2. A short course (6 months) anti-tuberculous therapy for neurotuberculosis was shown to be adequate; shunting of cases with hydrocephalus did not show definite benefit.