[Tuberculous meningitis in adults. Diagnostic elements: analysis of 32 cases]

The aim of this study was to determine the value of paraclinical investigations in the diagnosis of 32 adults with TB meningitis. Mycobacterium tuberculosis was found in spinal fluid cultures of 21 patients (66 p. 100). But only two had positive smears. In five with positive cultures the sampling was performed between one and 13 days after the beginning of chemotherapy. In 7 patients with negative spinal fluid cultures, mycobacterium tuberculosis was found in gastric contents aspiration (3); urine (2); bone marrow (1) and abscess (1). Cytochemical analysis of first spinal fluid samples showed an elevation of protein from 0.5 to 7 g/l in all patients (mean 2.1 +/- 1.6 g/l); sugar was low in 26 (mean 0.30 +/- 0.26 g/l); cell count was less than 500/mm3 in 26, with a mononuclear response in 24. 20 patients had lymphocytic and hypoglycorrachic meningitis. Cytochemical findings were independent of the delay between the first clinical symptoms and lumbar puncture. A. C. T. scan of the brain was performed in 8 patients with neurologic complications. Hydrocephalus was found in 3, and after the injection of contrast material, focal high-density areas in the basal cistern and the sulci of the cerebrum were observed in 2. Chest X ray showed miliary TB in 13 patients; but positive skin test for tuberculosis and hyponatremia were rarely helpful. To confirm adult tuberculous meningitis, we suggest that two spinal fluid samplings are necessary, but mycobacterium tuberculosis must be looked for simultaneously in the sputum, gastric contents, urine and bone marrow. Specific treatment can be started immediately after the first spinal fluid sampling. Chest X ray may be helpful, but C.T. scan of the brain and tuberculin test are of no value.