Treatment of tuberculous meningitis

Abstract

In the course of 12 years 210 consecutive children were admitted and treated for tuberculous meningitis. Of these 131 (63%) survived, and 105 (50%) have no neurological or mental sequelae. The results progressively improved with increased experience in management, and with the introduction of P.A.S. followed by isoniazid as specific anti-tuberculous drugs and P.P.D. and corticosteroids as adjuvants. Since the introduction of isoniazid 66 out of 80 children (83%) survived, and 55 of them have no sequelae. The most difficult patients are those who are under 3 years of age and are unconscious on admission, and none of those so far have made a complete recovery. Intrathecal streptomycin treatment has not been abandoned, but the minimum course is now reduced to 10 injections. The total duration of treatment is six months or longer, but most of this time the children are ambulant and either are treated at home or receive regular schooling in hospital. Systemic corticosteroids are used in children under 1 year of age or in those who are unconscious on admission; intrathecal hydrocortisone is of value in threatened or established spinal block. The work on which the paper is based has been continuously in progress over 12 years. It would never have been possible without the continuous help and confidence of Professor R. S. Illingworth and without the selfless contribution of many colleagues in the region who referred their patients to us for treatment. © 1960, British Medical Journal Publishing Group. All rights reserved.