Intrathecal Fibrinolysis with Streptokinase in Tuberculous Meningitis

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Abstract
The components of the plasminogen plasmin system have been detd. in the CSF of normal persons and of patients suffering from tuberculous meningitis (tub. men.) In tub. men. the CSF levels of plasminogen and antiplasmin are greatly raised. Suitable concns. of streptokinase (s, k.) produce free fibrinolytic enzyme in all specimens of CSF, but below a min. concn. of s. k. for each fluid, fibrinolytic activity is absent because of the presence of inhibitors. The concns. of s. k. required to produce free fibrinoolytic activity are sometimes greater than can be used clinically. The use of high intrathecal concns. of s. k. was shown to result in very low levels of enzyme in vivo, owing to the irritant action of s. k. on the meninges. The influence of these observations on clinical treatment is discussed, and the conclusion reached that intrathecal s. k. may be of limited value in the treatment of tub. men.