결핵성 뇌막염에서 뇌실외 배액이 예후에 미치는 영향

PROGNOSIS OF EXTRA VENTRICULAR DRAINAGE IN CHILDHOOD TUBERCULOUS MENINGITS

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 cpmplication 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 stage1,2,3. In 6 patients of clinical stagel, EVD was not done. In 21 patients of clinical stage2, outcomes were as followed. In VPS group after EVD(5 patients), one (20%) was improved without neurologic 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 patients), 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(71.4%)were improved without neurologic deficit, one(14.3%) was stationary and one(14.3%) died. In 19 patients of clinical stage3, 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.