Title: Utility of Serial Transcranial Doppler in Diagnosis of Intracranial Vasculopathy with Computed Tomography Correlation in Children with Tuberculous Meningitis
Authors: Dr Rupam Kumari, Dr Suresh Kumar Toppo, Dr Paras Nath Ram, Dr Rajeev Kumar Ranjan, Dr Pughaz Deivigan, Dr Vijay Agarwal
Background: Cerebral vasculopathy leading to infarct are the most serious complications of tuberculous meningitis (TBM). Transcranial Doppler (TCD) allows early diagnosis and monitoring of cerebral hemodynamics. It is real time, non-invasive and non-ionizing imaging modality.
Aims & Objectives: 1) To describe spectrum of findings and to detect cerebral vasculopathy in pediatric TBM patients by using TCD. 2) To determine reliability of TCD by correlating its findings with computed tomography (CT) findings and stage of the disease.
Materials & Methods: 40 children≤ 13 years with diagnosis of TBM referred in Department of Radiology of a Tertiary care Hospital, Rajendra Institute of Medical Sciences (RIMS), Ranchi from September 2017 – August 2018 underwent serial TCD imaging on day 1, day 3 & day 7 after obtaining written informed consent. Findings were analyzed and then compared with CT findings and stage of the disease.
Results: Out of 40 study subjects who underwent TCD imaging, 19 patients showed abnormal Doppler findings in the form of stenosis in 15, vasospasm in 4, and hyperemia in 2 children. Sensitivity and Specificity of TCD as compared to CT to detect stenosis in cerebral arteries were 91.7% & 85.7% respectively.
Conclusion: Serial TCD can be used as a reliable modality for early diagnosis and monitoring of intracranial vasculopathy in childhood TBM.
Keywords: Transcranial Doppler, Vasculopathy, Tuberculous Meningitis, Children, CT.