Optic disc swelling in a patient with tuberculous meningitis: a diagnostic challenge

Abstract

We discuss the diagnostic challenge in an adult patient presented with purely ocular symptoms diagnosed with tuberculous meningitis (TBM). A 38-year-old woman presented with bilateral painless blurring of vision. There were bilateral sixth cranial nerve palsy and bilateral optic disc swelling. Optic nerve function tests were normal. Patient was lucid with no signs of meningism. Brain imaging were normal. She had a positive Mantoux test, high erythrocyte sedimentation rate but no clinical evidence of active pulmonary tuberculosis infection. Her Quantiferon-TB Gold in-tube test was negative. Cerebrospinal fluid analysis revealed a high opening pressure but no biochemical parameters to suggest TBM, hence she was treated as idiopathic intracranial hypertension. A diagnosis of TBM was finally made following a positive PCR for Her vision improved with reduction in optic disc swelling following antituberculous treatment.

A clinical study of optic nerve involvement in patients with tuberculosis attending a tertiary health care center in North East

“…In our study most of patients with papilloedema were tubercular meningitis which is similar to case reported by Hanis Zuhaimy and Suengein Leow. 19 In our study, there were 4 cases of tubercular optic atropy, which was similar to study conducted by Gupta P, which also had 2 tubercular optic atophy case. 20 In our study, 2 cases of optic neuritis were detected.…”

Nonconvulsive status epilepticus as an unusual presentation of tuberculous meningoencephalitis: A case report

“…They can appear either during the active phase or as sequel of meningitis. 10 Here we report a rare presentation of TBM in a patient who presented with NCSE. This case highlights the importance of clinicians' awareness of unusual clinical presentations of TBM, because NCSE is hard to diagnose unless clinicians are aware of this possibility, as delayed diagnosis is associated with a poor prognosis.…”

“…The etiology of TBM seizures is multifactorial, and has been attributed to meningeal irritation, cerebral edema, tuberculoma, infarction, hydrocephalous, and hyponatremia, either individually or in combination. They can appear either during the active phase or as sequel of meningitis 10 …”

A case of papilledema with TB meningitis with bilateral abducent nerve palsy – A diagnostic challenge

“…Tuberculous meningitis (TBM) is most devastating form of tuberculosis (TB) in the central nervous system that may cause death or severe disability up to 50−60% of affected patient. [1] It is associated with high frequency of neurologic sequelae and mortality. Vision impairment and blindness in particular is a dreadful complication.…”