The response to steroids may be dramatic with rapid clearing of sensorium, regression of abnormalities of CSF, defervescence and relief of headache. Earlier It was believed that corticosteroids had no place in the management of tuberculous meningitis because the drug did not alter the clinical outcome, however, more recent studies have shown that corticosteroids improved both survival rate and neurological outcome in patients with tuberculous meningitis. Schoeman et al. confirmed the useful role of corticosteroids in young children. They observed that, in addition to survival, corticosteroids significantly improved intellectual outcome and enhanced resolution of the basal exudates and intracranial tuberculoma were shown by serial CT scanning. Prednisolone treatment (60 mg/day in adults and 1â3 mg/kg/day in children) is suggested in patients with tuberculous meningitis. The dosage may reduced by 50% in the second and third week and then be tapered gradually over the next 4 weeks. There is no need for intrathecal corticosteroids. The main argument against using corticosteroids is that they decrease meningeal inflammation and, in turn, can affect CSF penetration of anti-tuberculous drugs.
Last date updated on July, 2014