Abstract:

Objective To investigate the clinical features of tuberculous meningitis (TBM) complicated with cranial nerve injury.Methods A total of 486 clinical diagnosed TBM patients in Beijing Chest Hospital of Capital Medical University from June 2014 to December 2017 were collected. Of these, 414 (85.2%) cases had no cranial nerve injury (no cranial nerve injury group) and 72 (14.8%) cases with cranial nerve injury (with cranial nerve injury group). The clinical characteristics and outcomes of the two groups of patients were analyzed, as well as the risk factors for concurrent cranial nerve injury.Results Seventy-two patients with cranial nerve injury had fever (90.3%, 65/72), headache (90.3%, 65/72), nausea and vomiting (56.9%, 41/72), disturbance of consciousness (54.2%, 39/72), misdiagnosis rate (38.9%, 28/72) were higher than those without cranial nerve injury (77.3% (320/414), 66.7% (276/414), 22.7% (94/414), 31.4% (130/414), 26.6% (110/414), respectively) (χ ²=6.280, P=0.012;χ ²=16.334, P=0.000; χ ²=35.840, P=0.000; χ ²=14.015, P=0.000; χ ²=5.201, P=0.023, respectively); logistic regression analysis showed that the risk factors for cranial nerve injury in patients with TBM were symptom of headache (OR (95%CI)=4.109 (1.806-9.349), Wald χ ²=11.353, P=0.001), and disturbance of consciousness (OR (95%CI)=2.531 (1.493-4.290), Wald χ ²=11.901, P=0.001). Seventy-two patients with cranial nerve injury were more likely to have optic nerve (52.8%, 38/72) and oculomotor nerve (56.9%, 41/72) injury. Sixteen (22.2%) cases had two groups of cranial nerves involved and 3 (4.2%) cases had three groups of cranial nerves involved. After 2 months of anti-tuberculous drug treatment, 69 patients (95.8%) had complete recovery of cranial nerve injury, 1 patient (1.4%) died of serious illness, and only 2 patients (2.8%) left oculomotor and optic nerve sequelae. Conclusion It is not uncommon for patients with TBM to have cranial nerve injury. The rate of misdiagnosis is high. The symptoms of fever, headache, nausea and vomiting, and disturbance of consciousness are obvious. However, headache and consciousness disorder are closely related to the occurrence of cranial nerve injury. The cranial nerve injury can be recovered well after effective anti-tuberculosis treatment.

Key words: Tuberculosis, meningeal, Cranial nerve injuries, Disease attributes, Risk factors, Factor analysis, statistical