From the Departments of Neurology (M.W., S.F.), Aga Khan University, Karachi, Pakistan.
Department of Neurology, Rashid Hospital, Dubai, United Arab Emirates (M.K.).
Stroke. 2018 Oct;49(10):2288-2293. doi: 10.1161/STROKEAHA.118.021301.
Background and Purpose- Cerebral infarctions complicate a variable proportion of tuberculous meningitis (TBM) cases and adversely affect outcomes. The objective of this study was to evaluate the predictors of cerebral infarcts in patients with TBM and to assess their impact on mortality. Methods- The study was based on a retrospective chart review of all patients with TBM admitted to a tertiary care hospital between 2002 and 2013. Data were collected on basic demographics, conventional vascular risk factors, radiological findings, severity of TBM, and neurological outcomes. Data were analyzed using SPSS version 19.0. Binary logistic regression was done to determine the factors predictive of cerebral infarcts and of mortality in patients with TBM. Results- A total of 559 patients were admitted with TBM during the study period. Mean age was 41.9 years (SD, 17.7 years), and 47% were women. A quarter of the patients had stage III disease. One hundred forty-four (25.8%) patients had cerebral infarcts on brain imaging of which 3 quarters were acute or subacute. Those with cerebral infarcts were more likely to be >40 years of age (adjusted odds ratio [AOR], 1.7; 95% CI, 1.1-2.7) and to have hypertension (AOR, 1.8; 95% CI, 1.1-2.8), dyslipidemia (AOR, 9.7; 95% CI, 3.8-24.8), and diabetes mellitus (AOR, 2.2; 95% CI, 1.3-3.6). Presence of cerebral infarction was an independent predictor of mortality among patients with TBM (AOR, 2.1; 95% CI, 1.22-3.5). Conclusions- Cerebral infarcts complicate a substantial proportion of TBM cases. Conventional vascular risk factors are the most important predictors of infarction, and future efforts need to focus on these high-risk patients with TBM to reduce morbidity and mortality.
背景与目的-结核性脑膜炎（TBM）患者中存在一定比例的脑梗死并发症，且对预后有不利影响。本研究旨在评估 TBM 患者脑梗死的预测因素，并评估其对死亡率的影响。方法-该研究基于对 2002 年至 2013 年间在一家三级保健医院住院的所有 TBM 患者的回顾性病历审查。收集了基本人口统计学、常规血管危险因素、影像学发现、TBM 严重程度和神经结局等数据。使用 SPSS 版本 19.0 进行数据分析。采用二元逻辑回归分析确定 TBM 患者脑梗死和死亡的预测因素。结果-研究期间共有 559 例 TBM 患者入院。平均年龄为 41.9 岁（标准差为 17.7 岁），47%为女性。四分之一的患者患有 III 期疾病。144 例（25.8%）患者的脑部影像学检查显示有脑梗死，其中 3/4 为急性或亚急性脑梗死。患有脑梗死的患者更可能年龄>40 岁（调整后的优势比[OR]，1.7；95%置信区间[CI]，1.1-2.7）和患有高血压（OR，1.8；95% CI，1.1-2.8）、血脂异常（OR，9.7；95% CI，3.8-24.8）和糖尿病（OR，2.2；95% CI，1.3-3.6）。TBM 患者存在脑梗死是死亡的独立预测因素（OR，2.1；95% CI，1.22-3.5）。结论-脑梗死是 TBM 患者的一个重要并发症。常规血管危险因素是脑梗死的最重要预测因素，未来的研究需要重点关注这些存在 TBM 的高危患者，以降低发病率和死亡率。
