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The diagnosis of tuberculous meningitis remains an enigma despite recent technologic advances, such as computerized tomography (CT), magnetic resonance imaging (MRI), and more recently, poly­ merase chain reaction of the cerebrospinal fluid. We report a patient with tuberculous meningitis who, when treated with appropriate antitubercular medications, made no progress in her recovery. Approximately 5 weeks into therapy, she began oral corticosteroid therapy and had a successful resolu­ tion of her neurologic deficits and intracranial symp­ toms. Polymerase chain reaction on four samples of cerebrospinal fluid was consistently negative for Mycobacterium tuberculosis. We describe the useful­ ness and problems associated with polymerase chain reaction and discuss the controversy regard­ ing the late or delayed use of corticosteroids in the treatment of tuberculous meningitis ..

Tuberculous Meningitis: Successful Use of Delayed Corticosteroids in Treatment and Polymerase Chain Reaction in Diagnosis