The neurocritical care of tuberculous meningitis

Joseph Donovan, Anthony Figaji, Darma Imran, Nguyen Hoan Phu, Ursula Rohlwink, Guy E. Thwaites

Research output: Contribution to journalReview articlepeer-review

76 Citations (Scopus)


Tuberculous meningitis is the most severe form of tuberculosis and often causes critical illness with high mortality. Two primary management objectives are reducing intracranial pressure, and optimising cerebral perfusion, while killing the bacteria and controlling intracerebral inflammation. However, the evidence base guiding the care of critically ill patients with tuberculous meningitis is poor and many patients do not have access to neurocritical care units. Invasive intracranial pressure monitoring is often unavailable and although new non-invasive monitoring techniques show promise, further evidence for their use is required. Optimal management regimens of neurological complications (eg, hydrocephalus and paradoxical reactions) and of hyponatraemia, which frequently accompanies tuberculous meningitis, remain to be elucidated. Advances in the field of tuberculous meningitis predominantly focus on diagnosis, inflammatory processes, and antituberculosis chemotherapy. However, clinical trials are required to provide robust evidence guiding the most effective supportive, therapeutic, and neurosurgical interventions for tuberculous meningitis that will improve morbidity and mortality.

Original languageEnglish
Pages (from-to)771-783
Number of pages13
JournalThe Lancet Neurology
Issue number8
Publication statusPublished - 1 Aug 2019


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