Magnetic resonance venographic findings in patients with tuberculous meningitis: Predictors and outcome

Publication date: Available online 1 August 2018

Source: Magnetic Resonance Imaging

Author(s): Amrit Bansod, Ravindra Kumar Garg, Imran Rizvi, Hardeep Singh Malhotra, Neeraj Kumar, Amita Jain, Rajesh Verma, Neera Kohli, Praveen Kumar Sharma, Ravi Uniyal, Shweta Pandey

Abstract

Background

This study evaluated the prevalence and predictors of venographic abnormalities in tuberculous meningitis.

Material and methods

Consecutive patients of tuberculous meningitis were included in the study. Clinical evaluation, cerebrospinal fluid examination and contrast-enhanced MRI of brain were done. Every subject was subjected to time of flight magnetic resonance venography (MRV). Presence of filling defects at superior sagittal sinus, dominant transverse or sigmoid sinus, and non-visualization of deep venous system was suggestive of thrombosis. The presence of filling defects at non-dominant transverse or sigmoid sinus was considered suggestive of thrombosis only in the presence of corresponding changes in T1, T2, and GRE sequences, parenchymal changes or presence of collaterals. The patients were followed up for 6 months. A modified Barthel index ≤12 at 6 months was taken as poor outcome.

Results

Out of 107 patients, MRV was found to be abnormal in 12 patients (11.2%). The superior sagittal sinus was the most commonly involved sinus. On univariate analysis, the presence of vomiting (P = 0.004), altered sensorium (P = 0.004), seizures (P < 0.001), vision impairment (P = 0.038), papilledema (P < 0.001), diplopia, oculomotor palsies at baseline, and basal exudates (P = 0.004) were significantly associated with an abnormal MRV. On multivariate analysis, none of the above factors were found to be significant. No association was found between poor outcome and abnormal MRV.

Conclusion

MRV abnormalities suggestive of venous sinus thrombosis can occur in about 11% patients. Superior sagittal sinus is the most commonly involved sinus. An abnormal MRV is not associated with a poor outcome.

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