Comparison of cerebrospinal fluid characteristics in patients with tuberculous meningitis with and without cranial nerve palsy

Objectives: Tuberculous meningitis (TBM) represents the most severe form of extrapulmonary tuberculosis. One of the common complications of TBM is cranial nerve palsy. This study assessed the characteristics of cerebrospinal fluid (CSF) in patients with TBM and cranial nerve palsy, particularly in a tertiary care hospital in Surabaya, East Java, Indonesia. Materials and Methods: A retrospective analysis of patients diagnosed with TBM from January 2022 to December 2024 was conducted, collecting demographic details, clinical features, and laboratory results of 37 patients. Patients with TBM diagnosed with CSF Xpert Mycobacterium tuberculosis /Rifampicin. Analysis of CSF characteristics using nominal data represented using frequency tables while continuous variables were described using mean ± standard deviation. Comparisons of CSF profiles in TBM patients with and without cranial nerve palsy were analyzed using Fisher’s exact test. A p -value <0.05 was considered statistically significant. Results: A total of 37 patients enrolled in this study. Cranial nerve palsy was noted in 9 (24.3%) of patients with TBM. Of the patients, 4 (10.8%) had multiple cranial nerve palsies including the 3 rd , 4 th , and 6 th nerves, 2 (5.4%) presented with 2 nd and 3 rd cranial nerve palsies, 1 (2.7%) had isolated 3 rd cranial nerve palsy, 1 (2.7%) had 3 rd and 6 th cranial nerve palsy, and 1 (2.7%) had 7 th and 12 th cranial nerve palsy. Chi-square analysis indicated that lymphocyte levels exceeding 50% in CSF are significant factors for cranial nerve palsy. Conclusion: The prevalence of cranial nerve palsy was 24.3%, with lymphocyte levels >50% in CSF representing a significant predictor of cranial nerve palsy in patients with TBMs.