The application of adrenal corticosteroid to the treatment of tuberculousmeningitis

Objective To study the effect of combination of adrenal corticosteroid and antituberculous drugs for treating tuberculous meningitis Methods The patients' clinical states,cerebrospinal fluid parameters and prognosis were compared and observed after a treatment of combination of adrenal corticosteroid and antituberculous drugs and sole treatment of antituberculous drugs Results The average fever duration of 42 patients treated with corticosteroid and antituberculous drugs was 10 3±7 1 days, the headache disappearance 21 2±10 6 days and the stiff neck duration 19 4±11 1 days The 46 cases were given the sole treatment with antituberculous drugs for respectively 14 6±5 8 days, 25 7±11 4 days and 24 5±10 2 days Thus, the statistics showed obvious difference ( P <0 01, P <0 05 and P <0 01) For the patients treated with couticosteroid and antituberculous drugs on admission, leukocyte count of cerebrospinal fluid was (539 8±425 3)×10 6/L, the contents of glucose 1 64±0 47?mmol/L and the protein 1794±1588?mg/L In 30 days after the treatment, their leukocyte count, the contents of glucose and protein were respectively (104 2±88 4)× 10 6/L , 2 59±0 59?mmol/L and 1073±861?mg/L For Shanghai Hospital for Infectious Diseases, Shanghai 200083, China (Xu GG, Luo CY and Wu SM) patients who were given the sole treatment with antituberculous drugs, leukocyte count was (510 4±419 2)×10 6/L, the contents of glucose 1 75±0 59?mmol/L and the protein 1627±1086 mg/L on their admition In 30 days after the treatment, their leukocyte count, the contents of glucose and protein were (145 1±93 5)×10 6/L, 2 12±0 67?mmol/L and 1177±989?mg/L respectively A close examination of cerebrospinal fluid was carried out on the 30th day of the treatment, suggesting that there was a decline of leukocyte count ( P <0 05) and an increase of glucose value ( P <0 01) The combined treatment with corticosteroid and antituberculous drugs had a good effect for protein content, compared with cases given the treatment solely with antituberculous drugs The mortality of those in coma (4/14 vs 6/11) and those who were in the middle or the late stage (5/36 vs 10/36) was lower for those who were given a treatment of combination of corticosteroid and antituberculous ( P <0 05) Conclusion The application of couticosteroid and antitubrculous drugs can improve clinical states and reduce mortality in patients with tuberculous meningitis The patients may be given the treatment of corticosteroid at the following one or more conditions: (1) unconsciousness, (2) serious toxemia, (3) higher intracranial pressure and communicating hydrocephalus and (4) spinal block