Use of corticosteroids in tuberculous meningitis

Hydrocephalus, if communicating--ie, when flow of cerebrospinal fluid is blocked after it exits the ventricles--can be successfully managed in about 80% of children by medical treatment with furosemide (1 mg/kg per day), and acetazolamide (100 mg/kg per day) and both given every 6-8 h for the first month of treatment, whereas non-communicating hydrocephalus requires urgent ventriculo-peritoneal shunting.10 However, corticosteroids had no influence on raised intracranial pressure in one randomised study.10 It is of interest, regarding the pathogenesis of the basal exudate, that the immune dysfunction of HIV infection appears to prevent the formation of the basal exudate characteristic of tuberculous meningitis in immunocompetent individuals.10 The lack of any other established means of modulating or preventing the damaging immune response suggests that corticosteroids should remain part of standard therapy for tuberculous meningitis despite the fact that some survivors might only partly recover.