Studies of the Cerebrospinal Fluid Circulation in Tuberculous Meningitis in Children: Part II. A Review of 100 Pneumoencephalograms

Abstract

100 pneumoencephalograms were performed on 58 children suffering from tuberculous meningitis. No serious after-effects were noted. One or more blocks of other than spinal type were found in 30 cases. In all of these there was a block at the tentorial opening or in the basal cisterns. In 2 cases there was an additional block at the Sylvian aqueduct, and in 3 others in the foramina of the 4th ventricle. These blocks were usually present at or soon after the beginning of treatment. In no case of tentorial or basal cisternal block was there sub-arachnoid air. This sign preceded the hydrocephalus in 3 cases. In only 4 children was any degree of hydrocephalus seen when subarachnoid air was present. Hydrocephalus of varying degrees was found in 34 cases. In 3 hydrocephalic children cerebral cysts developed, in 2 cases spontaneously and in the other following a ventricular puncture. A close correlation was found between encaphalographic appearances and prognosis. After a minimum follow-up period of 11 mos., 16 of 18 children with normal encephalograms were alive and only one of the survivors was left with serious neurological sequelae. Of 26 children with abnormal encephalograms only 8 were alive after the same period of observation. They all have neurological or mental residual lesions, serious in 5. Of 9 cases of meningitis which relapsed, 5 had normal encephalograms and survived. The 4 others died. No absolute dividing line was found regarding mental development following recovery from tuberculous meningitis in children with normal and abnormal encephalograms, but only 1 child out of 16 became retarded where the final encephalogram was normal, and 3 of 8 children who survived with hydrocephalus are grossly retarded. In 2 cases considerable hydrocephalus was compatible with good intelligence.