Focus into the Clinico-pathological profile of tubercular meningitis while probing the determinant effects of Hyponatremia in assessing the clinical severity and outcome

Background: Tubercular Meningitis is an important life threatening manifestation of extra pulmonary tuberculosis. It is quite common in the developing countries and can influence the socio economic status as most of the cases occur in the working age group. Aims and Objectives: To study: 1. The clinico-pathological profile of patients with tubercular meningitis. 2. To assess the role of hyponatremia in relation to its incidence, impact and prognosis in tubercular meningitis. Materials and Methods: One year single centered observational study including 45 cases of tubercular meningitis in a tertiary care teaching hospital in north eastern India. Diagnosis of tubercular meningitis was based on CSF findings as per standard protocol. Serum sodium was estimated on presentation and repeated based on the clinical status and a value < 135 mmol/L was diagnosed as hyponatremia. Results and Observations: A male preponderance with a mean age of 31.97 years was observed with a peak in the age group of 21 – 30 years. The average duration of symptoms was 3 weeks and fever, headache, nausea, vomiting, seizures, altered consciousness and neurological deficits mostly cranial nerve palsies are the usual presenting features. Clear to turbid fluid, elevated protein, decreased glucose, increased ADA activity, lymphocytic pleocytosis were salient features in CSF which also showed AFB in few samples and positive PCR for Mycobacterium tuberculosis DNA in a substantial number of cases. Hyponatremia, seen in 46.6% of cases had a bearing on the clinical severity but was statistically insignificant in relation to mortality. Death was observed in 13.33% of total cases, 83.33% of which had hyponatremia. Conclusion: The study concluded with the inference that hyponatremia may be an important prognostic indicator in relation to the severity of tubercular meningitis.