A comparative study of serum vascular endothelial growth factor in patients with tuberculous meningitis with and without stroke

Background and objectives: Stroke in tuberculous meningitis (TBM) has been reported in approximately 13-57% of patients with TBM. There are several mechanisms postulated for stroke in tuberculous meningitis including the role of various cytokines, chemokines and vascular endothelial growth factor (VEGF). VEGF is a potent regulator of endothelial permeability.There is a paucity of data regarding comparison of VEGF levels in patients of TBM with and without stroke. The aim of the study was to compare Serum VEGF in patients of tuberculous meningitis with and without Stroke and correlate it with various clinical, biochemical and radiological features. Methods: We compared 40 patients of probable or definite TBM with 40 age and sex matched patients of TBM with stroke.The two groups were compared for duration of illness, BMRC staging, various clinical parameters, CSF parameters (cytology, glucose and protein), MRI Brain scan features and serum VEGF levels. Results: The serum VEGF levels were significantly higher in TBM patients with stroke as compared to patients without stroke. The mean serum VEGF levels were 499.338 ± 230.320 pg/ml in patients of TBM without stroke and 1218.372 ± 570.114 pg/ml in patients of TBM with stroke. On multivariate analysis, out of the significantly different variables between patients of TBM without stroke and with stroke(i.e. duration of illness at presentation, hemiparesis, GCS score, Stage 3 BMRC, CSF protein concentration, CSF sugar, CSF lymphocyte count, presence of hydrocephalus on MRI Brain scan and serum VEGF) only GCS score and serum VEGF levels were significant. Interpretation and conclusion: The stroke in tuberculous meningitis was correlated to higher serum VEGF levels, lower GCS score. We conclude that features such as presentation in stage 3 BMRC, poor GCS at presentation, increased duration of illness at presentation, hydrocephalus on MRI and high serum VEGF levels may predict the occurrence of stroke in TBM. *Correspondence to: Rajat Jhamb MD (Medicine), FACP, FICP, FIACM, Professor, Department Of Medicine, University college of Medical Science & GTB Hospital, Delhi, India 110095, Tel: +91-9625900556; E-mail: rajatjhamb@ yahoo.com