The effect of streptomycin on the lesions of tuberculous meningitis.

Abstract

The pathological findings in the central nervous system of 10 fatal cases of tuberculous meningitis are presented; all patients had received streptomycin therapy. The clinical course was prolonged up to 25 months. Acute inflammatory lesions in the leptomeninges showed regression except in the cases of short duration, and all degrees of fibrosis was observed. In general the arteries exhibited extensive intimal fibrosis and narrowing of the lumen, while the arterioles were severely obstructed or infiltrated by leucocytes. Obstructive adhesions about the spinal cord caused spinal fluid block in four patients who were treated by the intrathecal route. Internal hydrocephalus was a common complication, even in cases where the acute meningitis was largely healed. Infarction of the basal nuclei was not infrequent and could be ascribed to the vascular lesions. Tubercle bacilli were identified in the meninges and in small meningeal tuberculomas in patients who had received large doses of streptomycin.