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Dexamethasone in Tuberculous Meningitis: Relationship of Cerebrospinal Fluid Effects to Therapeutic Efficacy

RICHARD D. O'TOOLE, M.D.; GEORGE F. THORNTON, M.D.; MRINAL K. MUKHERJEE, D.P.H.; and R. L. NATH, PH.D.
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Baltimore, Maryland; and Calcutta, India


Ann Intern Med. 1969;70(1):39-48. doi:10.7326/0003-4819-70-1-39
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SUMMARY:

Dexamethasone was administered for 4 weeks in a double-blind manner as an adjunct to isoniazid and streptomycin treatment in 11 of 23 patients with moderately advanced or severe tuberculous meningitis. Five of 11 steroid-treated patients and 3 or 12 concurrent control patients survived.

Serial observation of cerebrospinal fluid (CSF) changes showed that significantly fewer steroid-treated patients exhibited elevated pressures by the fourth day of therapy. This improvement in pressures was associated clinically with a decreased incidence of the herniation syndrome during the first 72 hr in hospital.

CSF leukocyte counts and CSF sugar and protein concentrations returned toward normal values more rapidly in steroid-treated patients; however, it was not possible to correlate these findings with improvement in morbidity or mortality. Gastrointestinal blood loss and hypothermia were encountered more frequently among patients treated with steroids.

It was concluded that, despite the striking impact of dexamethasone on CSF, the only CSF effect that could be related to improved survival was attenuation of cerebral edema. The administration of steroids in high doses appears to be clearly indicated in the management of cerebral edema associated with tuberculous meningitis.

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