[Four cases of tuberculous meningitis--clinical significance of pleocytosis with polymorphonuclears as the predominating cell type in CSF].

It has been well known that tuberculous meningitis cases have moderate pleocytosis with mononuclears as predominating cell type in cerebrospinal fluid (CSF). But there are some reports of tuberculous meningitis in which polymorphonuclears was predominant in CSF. In this study, we investigated differential cell counts of CSF in 4 tuberculous meningitis cases. In 3 of the 4 cases, the CSF had a polymorphonuclears preponderance on admission. The elevated ratio of polymorphonuclears seemed to relate with the severity of the disease, and the ratio declined promptly after the initiation of chemotherapy. The 2 cases, which showed extremely high ratio of polymorphonuclears, showed poor prognosis, one died and the other had the severe sequelae such as notable disturbances of consciousness with hydrocephalus. This study suggests that differential cell counts of CSF is a useful measures to predict the prognosis and to follow up patients with tuberculous meningitis. The finding of a polymorphonuclears preponderance in CSF would suggest the severity and activities of the disease and should be considered as an alarm sign in tuberculous meningitis.