Background: Tuberculous meningitis (TBM), manifests as the most severe involvement of the nervous system by Mycobacterium tuberculosis, it has a high mortality rate and a spectrum of systemic and neurological complications that can lead to debilitating or fatal sequelae, whereas hyponatremia is the commonly encountered life-threatening electrolyte disturbance. Thus, our study aimed to determine the prevalence, risk factors and differences in outcomes of hyponatremia in TBM. Methods: This systematic review was registered in PROSPERO (CRD42018088089). A comprehensive electronic search was conducted through ten databases to find relevant articles. Results: A total of 42 studies were included, 24 case reports and 18 retrospective studies. The prevalence rate of hyponatremia among TBM patients was 52% and the rate of death among those patients was 29%. The meta-regression analysis revealed that there was no significant effect of sodium level on the death rate in TBM patients (P-value = 0.9). Additionally, there was no significant difference in sodium level based on sex, and etiologies of hyponatremia. Conclusions: Hyponatremia is commonly present in patient with TBM, but it is not significantly correlated to the rate of death. However, it is necessary to treat this potentially lifethreatening condition appropriately according to its etiology, further research is needed on its pathophysiology in TBM, its risk factors, and the most appropriate treatment.
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