External Ventricular Drainage as a Life Saving Bridge Therapy in Pediatric Tuberculous Meningoencephalitis with Acute Hydrocephalus: Improving Consciousness and Spasticity
DOI:
https://doi.org/10.29313/bcsms.v5i3.21663Keywords:
Tuberculous Meningoencephalitis, Hydrocephalus, External Ventricular Drainage, Neurological OutcomeAbstract
Abstract. Tuberculous Meningoencephalitis (METB) is one of the most devastating Central Nervous System (CNS) infections in children, with hydrocephalus being the primary cause of high morbidity and mortality. Surgical management of acute hydrocephalus secondary to METB is critical but often involves clinical controversy, particularly regarding the choice and timing of cerebrospinal fluid (CSF) diversion. Case Presentation: Tuberculous Meningoencephalitis (METB) is one of the most devastating Central Nervous System (CNS) infections in children, with hydrocephalus being the primary cause of high morbidity and mortality. Surgical management of acute hydrocephalus secondary to METB is critical but often involves clinical controversy, particularly regarding the choice and timing of cerebrospinal fluid (CSF) diversion. Intervention and Outcome: Post-EVD, the patient showed significant neurological improvement: consciousness improved from somnolent to apathetic, and generalized spasticity reduced to being localized in the right extremities. This short-term improvement, specifically in GCS and spasticity, highlights the immediate efficacy of EVD in managing acute neurological deterioration. Discussion: This case illustrates the critical role of EVD as an effective life-saving bridge therapy for acute hydrocephalus in advanced METB stages. It underscores the importance of clinical and radiological judgment (TBM Stage III) when microbiological evidence is lacking, and demonstrates that timely CSF diversion can mitigate acute symptoms even in the presence of established chronic sequelae (cortical blindness and cerebral palsy). This finding aligns with the need for better evidence synthesis on this topic. Conclusion: EVD is a necessary and effective intervention for pediatric METB-associated acute hydrocephalus, providing crucial short-term neurological improvement and serving as an essential step toward patient stabilization and subsequent definitive management.
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