Analysis of cerebrospinal fluid from 167 cases of tuberculous meningitis

Objective To analyze the characteristics of the cerebrospinal fluid (CSF) of patients with tuberculous meningitis, in order to provide an approach for earlier and correct diagnosis. Methods The clinical data of 167 patients with tuberculous meningitis hospitalized in General Hospital of PLA from Jan. 1994 to Jun. 2009 were collected. The clinical features of patients and results of laboratory tests of CSF (routine tests, biochemical tests, etc.) were analyzed, and then the characteristics of changes in CSF were evaluated. Results Out of 167 patients, CSF of 13 cases bore the typical clinical features of tuberculous meningitis, while that of the others were atypical: e.g. dramatical elevation of intracranial pressure (300mmH2O), non-purulent CSF with pleocytosis up to 2700×106/L, increased polykaryocytes in the early stage, normal or obviously high total protein level, normal glucose and chloride level, and negative laboratory examinations (such as culture-and smear-examination of Mycobacterium tuberculosis, adenosine deaminase, anti-TB antibody, immuno-dot-blot assay MycoDot and PPD assay). In this series of 167 patients, 7 of them died (3.7%). Conclusions The findings in CSF examination in most patients with tuberculous meningitis may show atypical findings, therefore it should be emphasized to repeat the analysis of CSF in order to obtain an accurate diagnosis of tuberculous meningitis.