Myelitis: A Common Complication of Tuberculous Meningitis Predicting Poor Outcome

Yuxuan Jiang; Xiangqin Xu; Zhuoxin Guo; Yuxin Liu; Jiahao Lin; Lijun Suo; Ying Jiang; Bo Liu; Tingting Lu

doi:10.3389/fneur.2022.830029

Myelitis: A Common Complication of Tuberculous Meningitis Predicting Poor Outcome

Front Neurol. 2022 Mar 16:13:830029. doi: 10.3389/fneur.2022.830029. eCollection 2022.

Authors

Yuxuan Jiang¹, Xiangqin Xu¹, Zhuoxin Guo², Yuxin Liu¹, Jiahao Lin¹, Lijun Suo³, Ying Jiang¹, Bo Liu³, Tingting Lu¹

Affiliations

¹ Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
² Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
³ Zibo City Key Laboratory of Respiratory Infection and Clinical Microbiology, Department of Pulmonary and Critical Care Medicine, Zibo City Engineering Technology Research Center of Etiology Molecular Diagnosis, Zibo Municipal Hospital, Zibo, China.

Abstract

Background: Myelitis is an important complication in patients with tuberculous meningitis (TBM). However, a paucity of publications exists on the spectrum of neurological and MRI findings of TBM-related myelitis. The risk factors and prognosis of myelitis in patients with TBM are not fully understood. Therefore, this study aims to identify the risk factors, clinicoradiological features, and prognostic impact of myelitis for patients with TBM.

Methods: We conducted a retrospective study in our institution. Patients with TBM who were consecutively admitted during the period of August 2015 to December 2019 were included. We reviewed the demographic characteristics, clinical, laboratory and MRI findings, and clinical outcomes of all of the included patients. The diagnosis of myelitis was identified by a hyperintensity on T2-weighted images that were associated with cord edema, enlargement, and marginal or no enhancement on contrast-enhanced images.

Results: A total of 114 patients were included. Myelitis occurred in 19 (16.7%) patients, five of whom paradoxically developed myelitis. The common clinical signs of myelitis were paraparesis (738.9%), quadriparesis (844.4%), urinary retention or constipation (1,477.8%), and paresthesias in the lower limbs (1,052.6%). In the MRI findings, the hyperintensities on T2-weighted images involved more than 3 spinal cord segments. Myelitis was often combined with other forms of spinal cord injury, including 10 patients (52.6%) with spinal meningeal enhancement, 7 patients (36.8%) with enlargement of the central canal of the spinal cord, 6 patients (31.6%) with tuberculoma, and 4 patients (21.1%) with arachnoiditis and 1 patient (5.3%) with cerebrospinal fluid (CSF) loculations. None of the 5 patients with paradoxical myelitis were complicated with spinal meningeal enhancement and arachnoiditis, while 4 patients were complicated with enlargements of the central canal of the spinal cord. In multivariable analysis, a grade III disease severity on admission [p = 0.003, odds ratio (OR) = 8.131, 95% CI: 2.080-31.779] and high CSF protein (p = 0.033, OR = 1.698, 95% CI: 1.043-2.763) were independent risk factors for myelitis. After the 6 months follow-up, myelitis (p = 0.030, OR = 13.297, 95% CI: 1.283-137.812) and disturbance of consciousness (p = 0.042, OR = 12.625, 95% CI: 1.092-145.903) were independent risk factors for poor outcomes.

Conclusion: Myelitis was a common complication of TBM and independently predicted a poor outcome. A grade III disease severity and high CSF protein on admission were independent risk factors for myelitis. Paradoxical myelitis was rarely complicated with spinal meningeal enhancements and arachnoiditis, indicating that the immune reaction may play a dominant role.

Keywords: immune reaction; myelitis; paradoxical reaction; prognosis; tuberculous meningitis.