The Use of Intrathecal Heparin in Conjunction with Streptomycin in the Treatment of Tuberculous Meningitis: Preliminary Report.

One of the commonest causes of failure in the treatment of tuberculous meningitis by streptomycin is the formation of intracranial and intraspinal adhesions with resultant hydrocephalus. These adhesions are produced par-tly as a result of the fibroblastic reaction that occurs around tuberculous foci, but their inception and growth may well be stimulated by the deposition of fibrin from the cerebrospinal fluid which is rich in fibrinogen in this condition. The photomicrograph (Plate Ila) illustrates that fibrin is, in fact, laid down in this condition. This was taken from the spinal cord of a child who had died from tuberculous meningitis after several weeks of treatment by streptomycin, and the masses of fibrin in the upper part of the picture can be clearly seen. If fibrin deposition is of importance in the formation of tuberculons adhesions, therefore, it might reasonably be hoped that the prognosis would improve if this could be prevented. The obvious drug for this purpose is heparin. We decided for this reason to investigate the possibility of introducing this substance into the cerebrospinal fluid with streptomycin, and to attempt to assess its value in the treatment of tuberculous meningitis. Our preliminary findings on the interaction of streptomycin and heparin appeared to be of sufficient interest to warrant this preliminary communication. The investigations so far completed, and the conclusions derived therefrom, are given below.