1 Unit for Treatment of Tuberculous Meningitis, Alexandra Hospital, Montreal
This particular group of children recovering from tuberculous meningitis have suffered a significant degree of intellectual impairment.
It appears that the factor having the most unfavorable influence in intellectual recovery is severe clinical illness as evidenced by convulsive seizures.
Loss of consciousness for some time during the early phase of tuberculous meningitis in itself does not appear to be a highly unfavorable sign. Nevertheless, when unconsciousness is associated with convulsive seizures the intellectual functioning of the patient, in most instances, can be expected to be seriously impaired.
An infant with tuberculous meningitis may be expected to have an unfavorable prognosis aside from any other factors. An older child, who has remained conscious throughout his illness and without convulsions, may be expected to have a relatively good prognosis.
Adverse social factors, prolonged hospitalization and isolation, and sensory-motor sequelae are considered to have influenced unfavorably the psychometric scoring of many of these children.
Repeat psychometric testing, after an interval, reveals that still further improvement in intellectual functioning may be expected in a number of these children who do not have serious sensory-motor impairment.
For the majority, however, repeat testing reveals that they have varied little from their previous performance; the normal children continuing to develop within their normal group whereas the retarded children have remained retarded.
It is noteworthy that observations on five adults treated at the Alexandra Hospital have been at some variance with the observations of Williams and Smith who found no measurable disturbance of intellect, personality or memory in 19 adult patients. Three of the five adults treated in this unit have obvious changes in personality in that they are unable to concentrate as formerly, are easily frustrated, childish and frequently quick-tempered. The remaining two patients appear to have no apparent intellectual or personality sequelae.
Although this is a study of a small number of children, it is hoped that other workers will undertake psychometric evaluation of children recovering from tuberculous meningitis and make their results known for comparison.