Treatment of Tuberculous Meningitis With Streptomycin

Tuberculous cerebrovascular disease: A review

“…Inflammation may be segmental 18,60,65 as well as diffuse. Tubercles, often with giant cells, sometimes with necrotic centres, may directly involve vessel walls, 20,35,60,69 usually the adventitia, 2,65,68,70 less often extending to the media or intima. 2,61 Thus, tuberculous cerebral vasculitis shares morphological features not only with other infectious vasculitides but also to some extent with immunological vessel disorders such as giant cell (temporal) arteritis, polyarteritis nodosa and Wegener's granulomatosis.…”

“…60,65 In his summary, Dalal concludes that ''it is extremely uncommon to find an organising thrombus in an appropriate vascular territory that matches the age of cerebral infarction''. 6 Conversely, some have suggested that thrombosis is important in causing venous thrombosis 60,61,69e71 or have emphasised spinal artery thrombosis, 17,69,76 whilst others assert that thrombosis is reasonably common in TBM, 15,35,41,44,60,61 usually in association with vasculitis. Dastur and Lalitha describe ''marantic thrombosis'', especially of venous sinuses, in longduration illness.…”

Tuberculous Meningitis

“…Drowsiness, voracious appetite (somewhat resembling the Kleine-Levin syndrome), facial flushing, glycosuria, hyperthermia, hyperalgesia, and emotional instability may be due to the hydrocephalus and its effect upon the midbrain, thalamic, and hypothalamic regions; or, on the other hand, the dominant lesion may be a tuberculous arteritis depriving these centres of their blood supply (Smith, Vollum, and Cairns, 1948).…”

Studies of the Cerebrospinal Fluid Circulation in Tuberculous Meningits in Children: Part I. The Use of Penicillin as a Tracer Substance

“…There is, however, less general agreement about the optimum site of cerebrospinal administration of streptomycin. The lumbar, ventricular, and cisternal routes are most commonly used, but streptomycin has also been injected through indwelling polyethylene catheters direct into the interpeduncular space (Cairns, 1949;Smith, Vollum, and Cairns, 1948) or into the pontine cistern (Komrower, 1950).…”

“…There are various views regarding the aetiology of these blocks. Tuberculous granulation tissue (M.R.C., 1948); fibrinous exudate which may become fibrous later (Cairns, 1949;Cathie, 1949;Smith et al, 1948;DanieL 1949); reaction to 'bloody tap' (Cairns and Taylor, 1949); the irritant effect of streptomycin (Cathala and Bastin, 1948;Winter, 1950); and herniation of the brain into the foramen magnum or tentorial opening (Cairns, 1949;Smith et al, 1948) have all been blamed. These may be responsible singly or in combination.…”