Saitoh et al developed the Tuberculous Meningitis Acute Neurologic (TBAN) score for evaluating children with tuberculous meningitis. This can help identify patients who may benefit from closer monitoring for neurologic sequelae. The authors are from the University of California, Children's Hospital and United States Naval Hospital in San Diego.
Severe neurologic sequelae include:
(1) cognitive impairment
(2) learning disabilities
(3) significant motor impairment, requiring assistance in all activities of daily living
Parameters:
(1) mental status
(2) seizures
(3) cranial nerve abnormality
(4) focal motor abnormality
(5) muscle tone
|
Parameter
|
Finding
|
Points
|
|
mental status
|
normal
|
0
|
|
|
lethargy
|
1
|
|
|
obtundation or stupor, rousable by noxious stimuli ("semicoma")
|
2
|
|
|
coma
|
3
|
|
seizures
|
none
|
0
|
|
|
controlled with medications
|
1
|
|
|
uncontrolled by therapy (persist despite therapy for > 12 hours)
|
2
|
|
cranial nerve abnormality
|
absent
|
0
|
|
|
present
|
1
|
|
focal motor abnormality
|
absent
|
0
|
|
|
present
|
1
|
|
muscle tone
|
normal or decreased
|
0
|
|
|
increased (hypertonic or spastic)
|
1
|
where:
• A cranial nerve abnormality may include: ophthalmoplegia, abnormal pupillary reactivity, facial nerve palsy, abnormal facial sensation, swallowing difficulty, uvula deviation, tongue deviation, and/or hearing abnormality.
• A focal motor abnormality includes abnormal deep tendon reflexes and/or asymmetrical weakness.
total score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 8
• The score is measured on days 0 and day 3 after hospitalization.
• A score >= 4 on day 0 and on day 3 is associated with severe neurologic sequelae.
Performance:
• The sensitivity on day 0 was 75% and specificity 92%.
• The sensitivity on day 3 was 88% and specificity 100%.
Limitations:
• The duraton of illness before presentation will vary.
