Raised intracranial pressure,the syndrome of inappropriate antidiuretic hormone secretion,and arginine vasopressin in tuberculous meningitis |
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| Authors: | Mark F Cotton Peter R Donald Johan F Schoeman Lana E Van Zyl Cor Aalbers Carl J Lombard |
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| Institution: | (1) Department of Pediatrics and Child Health, University of Stellenbosch and Tygerberg Hospital, Stellenbosch, Republic of South Africa;(2) Department of Chemical Pathology, University of Stellenbosch and Tygerberg Hospital, Stellenbosch, Republic of South Africa;(3) Institute for Biostatics, Medical Research Council, Parowvalley, Republic of South Africa;(4) Present address: Infectious Diseases Section, Department of Pediatrics, The Children's Hospital, 1056 East 19th Avenue, 80218 Denver, CO, USA |
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| Abstract: | Intracranial pressure (ICP) monitored shortly after admission over a period of 1 h in 31 children with tuberculous meningitis (TBM) was significantly higher (median 22.5 mm Hg, range 8.4–50.9 mmHg) in 19 children with laboratory evidence of the syndrome of inappropriate antidiuretic hormone secretion (SIADH) than in 12 children without such evidence (median 16.2 mmHg, range 5.8–42.5 mmHg; P = 0.027). Neither plasma nor cerebrospinal fluid arginine vasopressin (AVP) was related to ICP (r = 0.33 and 0.13 respectively). Mean arterial pressure (MAP) was measured in 23 children and a moderate correlation was found with plasma AVP (r = 0.62; P = 0.0019). In TBM, plasma AVP may be secreted as a response to raised ICP in an effort to raise MAP and maintain cerebral perfusion pressure. In this setting excess fluid may be inappropriately retained, leading to hyponatremia and hypo-osmolemia. |
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| Keywords: | Intracranial pressure Syndrome of inappropriate antidiuretic hormone secretion Arginine vasopressin Tuberculous meningitis |
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