TUBERCULOUS MENINGITIS AND BRITISH MEDICAL RESEARCH COUNCIL STAGING

ABSTRACT
Objective: The objective of this study was to determine and compare the BMRC staging of tuberculous meningitis.
Material and Methods: Patients admitted with diagnosis of meningitis i.e., fever, headache, altered mental status with 
or without neurological deficits with typical CSF analysis of lymphocytic pleocytosis with increased CSF protein and low 
CSF glucose concentration. These patients were declared as having tuberculous meningitis when they meet any one of 
the following criteria: (i) positive AFB staining and/or CSF culture and/or PCR assay for mycobacterium tuberculosis; (ii) 
history of contact with tuberculosis patient during last 2 months; (iii) evidence of tuberculosis anywhere else in the body 
(iv) patients with one or more of the following radiological features on MRI brain contrast study i.e. hydrocephalus and/
or basilar enhancement and/or tuberculoma formation. Patients having evidence of fungal meningitis, patient having 
evidence malignancy, connective tissue disease or chemotherapy were excluded. Patients were classified according to 
Stage I: conscious, have non-specific symptoms, no neurological deficits. Stage II: lethargy, behavior changes, signs 
of meningeal irritation, minor neurological deficits (involvement of cranial nerves). Stage III: stupor, coma, seizures, 
abnormal behaviors, severe neurological deficits.
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Results: A total of 115 patients were recruited in this study. Male gender dominated 65(56%) female patients were 
50(44%). Average age was 34 years ranging from 10 years to 78 years. All patients were grouped according to BMRC 
staging. Thirty six (31%) patients presented in BMRC stage 1, stage 2 patients were dominant 54(47%) the remaining 
25 (22%) were in stage 3. Headache was the predominant symptoms present in 108 (91%) patients followed by fever 
101 (87%) and altered mental status 68 (59%). Neck stiffness was the leading sign found in 105 (91%) patients fol-
lowed by 6th nerve palsy 68 (59%), papilledema 48 (41%), stroke in 25 (21%) and stupor 22 (19%). Basal meningitis 
was observed in 38 (33%) patients followed by hydrocephalus, infarction and tuberculomas measuring 26 (22%), 18