Corticosteroids as an adjuvant to the chemotherapy of tuberculous meningitis.

Abstract

Summary Present views on the value of corticosteroids as an adjuvant to chemotherapy in the treatment of tuberculous meningitis are discussed. Experience of the use of corticosteroids in the Oxford Tuberculous Meningitis Unit is presented. The case material studied falls into 2 groups. First, the ‘X Series’, comprising 159 patients transferred to Oxford after treatment had been begun elsewhere; and second, the ‘Main Series’, comprising 361 patients treated throughout their illness according to the Oxford regime of combined systemic and intrathecal chemotherapy, with the use of intrathecal PPD as an adjuvant. First, the course of the illness is described in 33 patients of the ‘X Series’ who were transferred to Oxford because they were not responding to treatment which included cortisone or its analogues. The incidence of abnormal neurological signs, hydrocephalus and spinal block in the group is discussed, and the later progress of the patients, after cortisone was withdrawn and treatment otherwise altered to conform with the Oxford regime, is presented. Secondly, the indications for the use of cortisone in patients of the ‘Main Series’, treated throughout their illness in Oxford, are discussed fully. Apart from replacement therapy or other non-specific indications, cortisone was held to be indicated in only 10 cases, for the management of acute cerebral or pulmonary oedema (6 cases), miliary tuberculosis with peritonitis and intestinal obstruction (1 case), and overwhelming tuberculous infection, causing excessive meningitic reactions or peripheral circulatory failure (3 cases). From close study of these cases conclusions are drawn as to the benefits, limitations, and dangers, of cortisone therapy. It is concluded that there is no place for the routine use of cortisone or its analogues in tuberculous meningitis.