Tuberculous meningitis (TBM) with hydrocephalus is a serious form of central nervous system (CNS) tuberculosis and is associated with high morbidity and mortality. Here's an overview of the epidemiology of TBM-associated hydrocephalus:
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### 🌍 Global Epidemiology - Prevalence: TBM represents about 1% of all TB cases, but it accounts for a significant proportion of neurological TB, especially in endemic regions. - Hydrocephalus occurs in up to 80% of TBM cases, particularly in advanced stages. - High-burden regions: South and Southeast Asia (e.g., India, Indonesia, Vietnam), Sub-Saharan Africa, and parts of Eastern Europe. - HIV co-infection increases the risk of CNS TB, including TBM.
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### 👶 Pediatric vs. Adult Populations - TBM is more common in children than adults. - Hydrocephalus is a particularly frequent complication in pediatric TBM, occurring in up to 85% of cases. - In adults, hydrocephalus occurs in 30–50% of TBM cases, often as communicating hydrocephalus.
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### 🧠 Types of Hydrocephalus in TBM - Communicating hydrocephalus: Most common; due to obstruction of CSF absorption in arachnoid granulations. - Non-communicating hydrocephalus: Less common; results from blockage of ventricular system (e.g., at the aqueduct of Sylvius).
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### 📈 Risk Factors for TBM-Associated Hydrocephalus - Delayed diagnosis or treatment - Advanced stage of TBM at presentation (MRC Stage II or III) - Younger age - HIV infection - Drug-resistant TB
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### ⚠️ Outcomes - Hydrocephalus in TBM is associated with:
- Poorer neurological outcomes
- Increased mortality
- Higher rates of long-term disability, especially if not promptly treated
- Early detection and management (e.g., medical vs. surgical interventions like VP shunt or ETV) are critical for prognosis.