The Use of Fibrinolytic Activators in Meningitis and Similar Conditions

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Abstract
The cerebrospinal fluid in health contains only traces of plasminogen but a rapid rise occurs with the onset of meningitis, whether bacterial or viral. This is most marked during the first few days but persists thereafter as long as the protein content remains high. Plasminogen in this form can be activated by streptokinase and urokinase to yield plasmin. With proper dosage of activator, utilization of plasminogen in the CSF is virtually complete. Given intraventricularly or intrathecally, purified preparations of these activators are well tolerated and appear to induce a fibrinolytic state in the CSF. By this means early deposition of fibrin was probably prevented or cleared in 8 cases of meningitis and ventriculitis out of 17 treated. Antibodies and inhibitors to these activators were not detected in the CSF even after repeated administration. Other factors influencing the response to treatment are discussed.