Transcranial Doppler ultrasonography in hydrocephalic children with tuberculous meningitis.

Studies have shown a close correlation between congenital hydrocephalus (CH) and the Gosling pulsatility index (PI) determined by transcranial Doppler ultrasonography (TCD). There have not previously been similar studies in children with hydrocephalus from tuberculous meningitis (TBM), and in particular where arteritis is a prominent feature. Fifteen children from each of these two groups were prospectively examined by TCD before and after CSF diversion. Fifteen children without hydrocephalus were similarly evaluated as controls. The fall in PI following surgery was compared. The mean fall in PI in the congenital hydrocephalic group was 0.723 (SD, 0.42) as compared with 0.089 (SD, 0.16) in the TBM group (p = 0.0001). Ten of the 15 children in the TBM group had infarcts revealed by CT. In these, the PI significantly postoperatively (p = 0.004), (0.014; SD, 0.12) when compared with values obtained (0.24; SD, 0.11) in five children without infarcts. These findings indicate that the clinically relevant fall in PI following CSF diversion in children with congenital hydrocephalus does not necessarily occur in children with hydrocephalus secondary to TBM, especially when complicated by cerebral infarcts.