Abstract

Aim and Objective: To assess the effectiveness of intrathecal hydrocortisone, hyaluronidase and intravenous magnesium sulphate in cases of tuberculous meningitis.

Methods: The present study was carried out in the Postgraduate Department of Medicine, S.N. Medical College, Agra, comprising of 60 cases to tubercular meningitis.  The diagnosis was suspected on clinical ground and confirmed by cerebrospinal fluid examination and associated CT scan findings.  The patients were divided into 3 groups. 20 patients of Group A received treatment with antitubercular drugs and systemic steroids in standard dosages.  20 patients of Group B received intrathecal hyaluronidase (1500 IU) + intrathecal hydrocortisone (50 mg) in addition. 20 patients in Group C received intravenous magnesium sulphate in addition to standard treatment.

Result: The result were analyzed at 3 weeks and 6 weeks. Regular follow up examination was done at 1 – 2 month interval.  Final results were analyzed according to the latest follow up report available.  The basis of analyzing the result was the improvement in the clinical outcome of the patients along with change in cerebrospinal fluid. There was reduction in cerebrospinal protein in all 3 group but reduction in cerebrospinal fluid protein was more in Group B receiving intrathecal therapy as compared to other Groups and this was statiscally significant.  Clinical evaluation of patients was done on day 1, 7, 42 in different groups using modified rankin score and Barthel index.  It was found that recovery was much faster and clinical improvement occur earlier in patients receiving intrathecal therapy.  Magnesium sulphate although did not caused rapid resolution of cerebrospinal fluid but it helped in earlier clinical improvement in patients especially those with tubercular arteritis.

Conclusions: Intrathecal hyaluronidase and hydrocortisone as an adjuvant to antitubercular treatment is very useful in cases of tuberculous meningitis particularly at advanced stage of disease, Magnesium sulphate when given intravenous to patients of tubercular meningitis with arteritis helps in early clinical recovery as evidenced by change in Barthel Index and Modified Rankin Index.