Blood-CSF-barrier permeability in tuberculous meningitis and its association with clinical, MRI and inflammatory cytokines

Abstract Objective: Blood -cerebrospinal fluid (B-CSF) barrier disruption in tuberculous meningitis (TBM) may be mediated by inflammatory cytokines and may determine clinico–radiological severity and outcome. We report B-CSF permeability in TBM and its relationship with inflammatory cytokines (TNF-α, IL-1β and IL-6), clinical severity, MRI changes and outcome. Methods: Fifty-five TBM patients with a median age of 26 years were included. Their clinical, CSF and MRI findings were noted. Severity of meningitis was graded into stages I to III. Cranial MRI was done and presence of exudates, granuloma, hydrocephalus and infarctions was notes. B-CSF permeability was assessed by a ratio of CSF albumin to serum albumin (Q alb ).Concentration of TNF- α, IL-1β and IL-6 in CSF was measured by CBA. Results: The Q alb in the patients was more than mean+2.5 SD of controls. In TBM, Q alb correlated with TNF- α (r=0.36; p=0.01), CSF cells (r=0.29; p=0.02) and exudate on MRI (0.18 ± 0.009 Vs 0.13 ± 0.008; p=0.04). There was however no association of Q alb with demographic variables, stage, tuberculoma, infraction and hydrocephalus. At 6 months, 11(20%) died, 10(18.2%) had poor and 34(61.8%) had good recovery. Conclusion: B-CSF permeability in TBM correlated with TNF-α, CSF pleocytosis and exudates but not with severity of meningitis and outcome.