Modern Treatment and Late Prognosis of Tuberculous Meningitis

Summary Certain controversial subjects in the treatment of tuberculous meningitis are analyzed, amongst them intrathecal administration of streptomycin, the toxicity of isoniazid, long‐term treatment with INH, and the etiological role of the primarily resistant strains of tubercle bacilli. The corticoid problem is given special consideration and the possibility of iatrogenic late sequelae due to corticoids is discussed at length. The importance of proper neurosurgical management in cases with increased intracranial pressure and signs of block formation and the value of preventive measures, like BCG vaccination, chemoprophylaxis and isolation are also stressed. In addition, the methods of treatment presently employed at the Children's Hospital are presented in detail and certain therapeutical problems are discussed in this connection. The recent results, from the years 1956—62, are outlined. Finally, in the late prognosis of the survivors of tuberculous meningitis the emphasis is laid upon certain sociomedical aspects and the children are grouped into: Group A — 50 –60 per cent — fully recovered individuals with no handicaps; Group B – 30—40 per cent — individuals with minor handicaps requiring efficient rehabilitation and special training but with a favourable socio‐medical prognosis when given these; and Group C — 10 per cent — severely handicapped individuals at the mercy of the domestic environment and or the community.