Intrathecal Isoniazid for Refractory Tuberculous Meningitis with Cerebral Infarction
نویسندگان
چکیده
A 30-year-old Vietnamese woman, about 19 weeks pregnant, was admitted for acute cerebral infarction with stenosis of the left middle cerebral artery (LMCA), tuberculous meningitis, and miliary tuberculosis. Treatment with heparin, quadruple anti-tuberculosis therapy, and dexamethasone afforded prompt symptomatic improvement. However, she delivered a stillbirth, after which there was recurrence of acute cerebral infarction with LMCA occlusion, sinus thrombosis, and cranial base inflammation. A thrice-weekly 100 mg dose of intrathecal isoniazid (INH) improved the signs of meningeal inflammation. The patient was discharged ambulatory after 7 months. In refractory tuberculous meningitis, multimodal therapy with intrathecal INH and steroids should be considered.
منابع مشابه
Tuberculous meningitis treated with streptomycin and isoniazid without intrathecal therapy.
Isoniazid given orally readily and rapidly diffuses into the cerebrospinal fluid in health and disease (Fletcher, I952, 1953) and probably, also, gains access to tubercle bacilli within the cells. Adequate bacterio-static level of the isoniazid in the cerebrospinal fluid was found in both lower and higher doses. Throughout the illness Ritchie (I953) showed that isoniazid is more diffusible in t...
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