Bladder dysfunction and urodynamic study in tuberculous meningitis

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• 作者：Arvind Gupta^a ; Ravindra Kumar Garg^a ; ^{garg50@yahoo.com} ; Maneesh Kumar Singh^a ; Rajesh Verma^a ; Hardeep Singh Malhotra^a ; Shiv Narayan Sankhwar^b ; Amita Jain^c ; Ragini Singh^d ; Anit Parihar^d
• 关键词：Tuberculous meningitis ; Urodynamic study ; Arachnoiditis ; Bladder dysfunction
• 刊名：Journal of the Neurological Sciences
• 出版年：2013
• 出版时间：15 April, 2013
• 年：2013
• 卷：327
• 期：1-2
• 页码：46-54
• 全文大小：1080 K

文摘

Background

Micturitional disturbances in tuberculous meningitis have been reported infrequently and that too without urodynamic studies. Bladder dysfunction in tuberculous meningitis is often considered secondary to tuberculous radiculomyelopathy. We, in this study, evaluated the incidence and pattern of bladder dysfunction in tuberculous meningitis.

Materials and method

In this prospective study, 51 patients were included. In addition to clinical evaluation, patients were subjected to a urodynamic study along with magnetic resonance imaging (MRI) of brain and spine. Patients were followed up for 6 months. A follow-up urodynamic study was performed after 6 months.

Results

Out of 51 patients, urinary symptoms were present in one-third of the patients. Approximately, 70 % (36) of the patients had urodynamic abnormalities. The commonest (22/51) urodynamic abnormality was detrusor hyporeflexia/areflexia. Other urodynamic abnormalities were neurogenic detrusor overactivity in 10, detrusor sphincter dyssynergia in 6, normal detrusor activity in 19, reduced bladder sensation in 12, raised cystometric capacity in 9, and larger volumes of post-void residual urine in 12 patients. Six patients were unable to void on command. Three patients with neurogenic detrusor overactivity had leak during study. MRI showed spinal meningeal enhancement in 37, lumbosacral arachnoiditis in 25, myelitis in 12 patients, CSF loculations in 6, and cord atrophy in 5 patients. Spinal arachnoiditis and urinary symptoms showed significant association with urodynamic abnormalities. Follow-up urodynamic study showed resolution of urodynamic abnormalities in 72.6 % of the patients with treatment. Seven (28 % ) patients, with normal baseline urodynamic findings, paradoxically developed new abnormalities.

Conclusion

Bladder dysfunctions, in tuberculous meningitis, are frequently encountered. A significant association exists between urodynamic abnormalities and tuberculous lumbosacral arachnoiditis and myeloradiculopathy.