Bromide 82 in the Diagnosis of Tuberculous Meningitis

To the Editor.—  In their recent review of 52 patients with tuberculous meningitis (TBM) Kennedy and Fallon (241:264, 1979) noted that delay in diagnosis was an adverse prognostic factor, and they reviewed the difficulties in making the early diagnosis of TBM. They did not mention the radioactive bromide partition test, and I would like to draw attention to this simple procedure.Following Walter's¹ monograph in 1929 on the "blood-brain barrier," the use of the bromide test in disease of the brain and spinal cord became widespread. Nicol and Fawns² reported that in 26 cases of lymphocytic meningitis, all of those who had TBM had a decreased blood-CSF ratio. There were no false-negatives. Crook and colleagues³ reported the use of bromide 82 and found this to be a simple and reliable method using small samples. In separate studies, Mandal et al⁴ and I (unpublished data) have subsequently