Tuberculous mentingitis is the major cause of death in childhood tuberculosis, and early diagnosis and treatment are important prognositic factors. Hydrocephlus is common and serious complication that affect the neurologic outcome. In the
management of
hydrocephalus, instead of ventriculo-peritioneal shunt(VPS)after clinical improvement with only antituberculous chemotherapy, early decompression of increased intracranial pressure by extraventricular drainage(EVD) makes rapid recovery of mental
or
clinical status and decreases incidence of VPS and improves prognosis.
We did EVD in 19 patients of severs hydrocephalus or altered mentality due to hydrocephalus among 59 tuberculous meningitis patients who was admitted to Pediatric Department of SNUCH from March, 1987 to March, 1992. Thirteen Patients who didn't
have
hydrocephalus were excluded and we studied with 46 patients.
During 48 hours after EVD, headache, vomiting, seizure, fever and abnormal neurologic finding improved about half of the patients. For evaluating and comparing prognosis of EVD or VPS group, we classified 46 patients according to clinical stage
1,2,3.
In 6 patients of clinical stage 1, EVD was not done. In 21 patients of clinical stage 2, outcomes were as followed. In VPS group after EVD(5 patients), one (20%) was improved without neurolgic deficit, two(40%) were improved with neurologic
deficit
and
two(40%) were stationary. Two patients of non-VPS after EVD were improved in all cases. In VPS group without EVD(7 patienrs), two(28.6%) were improved without neurologic deficit, four(51.7%) were stationary and one(14.3%) was aggravated. In
conservative
therapy group(7 patients), five(7.4%) were improved without neurologic deficit, one(14.3%) was stationary and one(14.35%) died.
In 19 patients of clinical stage 3, early EVD were done in all VPS group. There is no statistical significance in comparing these groups because of small patients numbers and selection bias among these groups. But clinical outcomes suggest that
early
EVD helps to improve the prognosis of severe hydrocephalic patients with tuberculous meningitis.
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