Paradoxical vision loss associated with optochiasmatic tuberculoma in tuberculous meningitis: A report of 8 patients

Sinha, Mumun; Garg, Ravindra Kumar; Anuradha, H.K.; Agarwal, Atul; Parihar, Anit; Mandhani, Palavi Aga

doi:10.1016/j.jinf.2010.03.013

Cited by 29 publications

(11 citation statements)

References 20 publications

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“…Literature reports available are from 27% to 32%. [1517] Motor disability in our patients is similar to what is reported in literature. [14] Constitutional symptoms in the form of malaise, loss of appetite, myalgia, fatigue were present in 39 (90.7%) of patients.…”

Section: Resultssupporting

confidence: 90%

Factors Determining the Clinical Spectrum, Course and Response to Treatment, and Complications in Seronegative Patients with Central Nervous System Tuberculosis

Chandra

Advani

Kumar

et al. 2017

Journal of Neurosciences in Rural Practice

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Introduction:Tuberculous meningitis remains a major health issue in the community affecting young adults of both genders predominantly from rural background. In India, the disease continues to kill 2 people every 3 min or nearly 1000 daily, according to the Tuberculosis Control Society India. Tuberculosis (TB) of central nervous system (CNS) is the most devastating form of TB. As this disease is associated with very high prevalence in young adults and will ultimately contribute to great workforce loss, we decided to assess the factors deciding the disease and its course in our patients.Patients and Methods:Seronegative patients with probable CNS TB and attending our outpatient department were included and followed up for 2 years.Results:Low body mass index, low proteins, albumin, and low CD3 and CD4, pulmonary TB appears to be a common denominator in a vast majority of these patients. Delay in diagnosis and hyponatremia contributes to morbidity. The location of exudates causes morbidity when they are seen in optochiasmal region. Bacille Calmette–Guerin (BCG) vaccination status in the community appears to be very small.Conclusion:CNS TB causes considerable morbidity and mortality in rural young adults resulting in severe manpower loss. Awareness into the possible role of BCG in reducing the complications of TB, role of nutrition and immunity even in seronegative patients and high-degree suspicion in medical professionals can bring down the burden of this deadly disease in the society.

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Section: Resultssupporting

confidence: 90%

Factors Determining the Clinical Spectrum, Course and Response to Treatment, and Complications in Seronegative Patients with Central Nervous System Tuberculosis

Chandra

Advani

Kumar

et al. 2017

Journal of Neurosciences in Rural Practice

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“…In a recent prospective study of 101 patients of tuberculous meningitis, 26.7% of the patients were found to have blindness or low vision; optochiasmatic arachnoiditis, optochiasmal tuberculoma and hydrocephalus, in that order, were found to be the most common causes of visual impairment. Predictors of deterioration of vision were found to be papilledema, cranial nerve palsies, raised cerebrospinal fluid protein (>1 g/L), and evidence of optochiasmatic arachnoiditis on imaging [5]. Ocular tuberculosis per se in the form of uveitis, macular edema, endophthalmitis and panophthalmitis may also lead to visual impairment with or without any evidence of extra-ocular source of tuberculosis [9,10].…”

Section: Discussionmentioning

confidence: 97%

“…Impairment of vision is a devastating complication of tuberculous meningitis affecting 26% to 72% patients and causing significant disability [3,[5][6][7][8]. Pathologies or pathophysiological mechanisms attributing to the development of visual impairment in tuberculous meningitis are optic nerve involvement, optochiasmatic arachnoiditis, compression at the level of optic chiasm, optic nerve granuloma, choroidal tubercles, retinal vasculitis, hydrocephalus and ethambutol toxicity [2][3][4].…”

Section: Discussionmentioning

confidence: 99%

An unusual cause of visual impairment in tuberculous meningitis

Malhotra

Garg

Gupta

et al. 2012

Journal of the Neurological Sciences

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“…The basal exudates in TBM are prominent in the interpeduncular fossa, sometimes around the chiasma, known as optochiasmatic arachnoiditis. Sometimes, these exudates may occlude the blood vessels supplying the optic nerve or may be affected by tuberculous vasculitis 7 9. Such ischaemic involvement of the optic nerve causes destruction of optic nerve fibres leading to optic atrophy.…”

Section: Discussionmentioning

confidence: 99%

Unusual fundus examination findings in tuberculous meningitis

Verma

Chaudhari

2013

BMJ Case Reports

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Vision impairment is one of the devastating complications of central nervous system tuberculosis (CNS TB). Optic atrophy is a sequelae of various forms of CNS TB which, ultimately, is responsible for vision impairment. It is usually the secondary optic atrophy which occurs in CNS TB. In this case report, we present two cases of CNS tuberculosis developing primary optic atrophy, which is infrequently reported. The relevant pathophysiology and causes of vision impairment in CNS TB are also discussed.

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Paradoxical vision loss associated with optochiasmatic tuberculoma in tuberculous meningitis: A report of 8 patients

Cited by 29 publications

References 20 publications

Factors Determining the Clinical Spectrum, Course and Response to Treatment, and Complications in Seronegative Patients with Central Nervous System Tuberculosis

Factors Determining the Clinical Spectrum, Course and Response to Treatment, and Complications in Seronegative Patients with Central Nervous System Tuberculosis

An unusual cause of visual impairment in tuberculous meningitis

Unusual fundus examination findings in tuberculous meningitis

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