Introduction

Tuberculosis (TB) represents a leading cause of infectious disease related deaths globally. TB mortality continues to rise, with untreated cases resulting in up to 50% fatalities [1]. Per the WHO, over 100,000 individuals develop tuberculous meningitis (TBM) annually [2]. As the most severe manifestation of TB, TBM confers substantial neurological morbidity and high mortality. Approximately 80,000 adults were estimated to die from TBM in 2019, with around 30% average mortality [3, 4]. Overall mortality risk reaches 23% by 3 months and 25% by 12 months post-diagnosis [5], with associated disability or death approaching 50% [6,7,8,9]. This confers tremendous personal and public health burden.

Due to ambiguous initial presentation and diagnostic challenges, most TBM patients fail to receive timely intervention [10, 11]. Moreover, many present at later stages of illness (stage II/III) [12, 26]. Peripheral neurological deficits may manifest as hemiplegia, vision or hearing loss, ataxia, unresponsiveness, among others [27, 28]. In our study, 63.9% of long-term deceased patients presented with peripheral neurological symptoms, such as numbness, facial asymmetry, limb weakness, fine motor dysfunction, and urinary and fecal incontinence. These symptoms significantly impaired the patients’ self-care ability and negatively impacted their quality of life, leading to feelings of inferiority, guilt, and loneliness [29]. Quality of life and mental well-being significantly influence disease progression, and strong familial and social support are crucial in enhancing treatment adherence [30]. Therefore, it is essential to mobilize resources for patients diagnosed with advanced TBM to provide psychological support, alleviate negative emotions, and improve their motivation and confidence in adhering to their treatment regimen.

Existing literature suggests a strong association between hydrocephalus and adverse outcomes, including mortality, in TBM patients [31,32,33], particularly those with higher MRC classification. Our study reaffirms these findings. The inflammatory response elicited by mycobacterium tuberculosis infection in the subarachnoid space can lead to a viscous exudate obstructing the subarachnoid space at the brain base, causing hydrocephalus [21]. This common intracranial complication can occur at any stage of TBM and often results in increased intracranial pressure [34]. This may be a primary contributor to elevated intracranial pressure in TBM patients, leading to functional impairments affecting learning, memory, and movement [35], and in severe cases, coma, brain herniation, or death. Head CT/MRI is a reliable tool for diagnosing and assessing the severity of hydrocephalus in TBM patients [36, 37]. Medical professionals should closely monitor imaging results, especially signs of hydrocephalus, in Stage II/III TBM patients. Prompt review of CT or MRI scans is crucial if changes in consciousness level or pupils are observed.

Limitations

The present study has several limitations, including its retrospective design, single-site sampling, reliance on our hospital’s patient records, and relatively small sample size. Future investigations would benefit from a larger sample size and a multi-center, prospective study design.

Conclusions

Age, GCS score, peripheral neurological dysfunction, and hydrocephalus are independent predictors of long-term mortality in advanced TBM patients. Therefore, healthcare professionals should pay close attention to these clinical manifestations, enhance assessment procedures, and provide timely intervention.