A Comparative Study of Serum Matrix Metalloproteinase-9 in Tuberculous Meningitis With and Without Stroke

Background: Tuberculous meningitis is defined as an inflammatory response to mycobacterial bacterial infection of the pia, arachnoid and CSF of the subarachnoid space. It is a dangerous form of extrapulmonary tuberculosis because it can cause permanent neurological disabilities and even death. Stroke is a devastating complication which further increase the morbidity and mortality in the disease. Matrix metalloproteinases are endopeptidases which degrade all the components of the extracellular matrix and thus have potential to disrupt blood brain barrier and cause CNS damage. Matrix metalloproteinases have been associated with pathophysiology of ischemic stroke. MMP levels in serum and CSF have also been seen to rise with advancing stage of TBM. So it is postulated that MMP may have role in the pathophysiology of stroke in TBM and may serve as a biomarker to predict stroke in TBM. Aims: To compare Serum Matrix metalloproteinase-9 in patients with Tuberculous Meningitis with and without Stroke and correlate it with various clinical, biochemical and radiological features of TBM. Methods: 40 Patients of probable or definite TBM and 40 age and sex matched patients of TBM with clinical stroke were enrolled in the study and formed two groups i.e. cases and controls. The two groups were compared for various clinical parameters, biochemical parameters (CSF cytology, glucose and protein), neuroimaging parameters and serum MMP-9 levels. Serum MMP-9 was estimated by ELISA method. Results: Serum MMP-9 levels were (224 ± 261.627 ng/ml) in cases and (157.23 ± 197.155 ng/ml) controls, which though higher in cases but no difference was statistically significant (p value 0.157) between two groups. Also there was no correlation between the serum MMP-9 levels and various clinical features (duration of illness, fever, headache, vomiting, weight loss, seizure, hemiparesis), CSF characteristics (protein, sugar and cytology) and radiological findings (tuberculoma, and hydrocephalus). Conclusion: we conclude that MMP-9 levels is not correlated with occurrence of stroke in TBM. MMP-9 levels were not increased with severity of disease, complications and outcomes.