Vision impairment in tuberculous meningitis: Predictors and prognosis

Sinha, Mumun; Garg, Ravindra Kumar; Hk, Anuradha; Agarwal, Atul; Singh, Maneesh; Verma, Rajesh; Shukla, Rakesh

doi:10.1016/j.jns.2009.12.012

Cited by 62 publications

(46 citation statements)

References 14 publications

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“…One study found optochiasmatic arachnoiditis in 41% of patients with tuberculous meningitis having vision loss. 1 Hydrocephalous, which has been found to be associated with vision loss, was present in three of our patients. Other possible causes of vision loss such as ethambutol toxicity, occipital lobe tuberculoma or infarct, optic nerve tuberculoma, and choroid tubercle were not present in any of our patients.…”

Section: Discussionmentioning

confidence: 54%

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

Sinha

Garg

Anuradha

et al. 2010

Journal of Infection

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Section: Discussionmentioning

confidence: 54%

“…1 Optochiasmatic tuberculoma may appear paradoxically in patients with tuberculous meningitis while they receive adequate antituberculosis treatment. Paradoxical deterioration in tuberculous meningitis is a well recognized entity.…”

Section: Introductionmentioning

confidence: 99%

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

Sinha

Garg

Anuradha

et al. 2010

Journal of Infection

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“…Several studies in the past had [24]. Many manifestations of paradoxical reactions like optochiasmatic and spinal arachnoiditis, and a large cerebral tuberculoma are serious conditions associated with severe disabilities, and a potential for death [25]. These conditions warrant urgent treatment with immunomodulatory drugs.…”

Section: Discussionmentioning

confidence: 99%

Miliary Tuberculosis Mimicking Brain Metastasis from Renal Cell Carcinoma

Park

et al. 2018

J Neurocrit Care

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Background: Awareness about paradoxical reactions in tuberculous meningitis is crucial as a paradoxical reaction may lead to certain wrong conclusions (for example, an erroneous diagnosis, and a possibility of treatment failure, mycobacterial drug-resistance, drug toxicity, or presence of a malignancy). The present study was planned to evaluate the incidence and predictive factors of paradoxical reactions in light of clinical, cerebrospinal fluid, and neuroimaging characteristics. Methods: In this prospective cohort study, consecutive patients fulfilling the International Consensus criteria of tuberculous meningitis were included. Patients were subjected to clinical evaluation, cerebrospinal fluid evaluation, and neuroimaging. Patients were treated with anti-tuberculosis drugs along with corticosteroids. Patients were regularly followed up at 3 monthly intervals. At each follow up patients were evaluated clinically and repeat cerebrospinal fluid analysis was performed along with repeat neuroimaging. Disability assessment was done using Barthel index. Results: We enrolled 141 patients of tuberculous meningitis. Approximately one-third of patients (44/141; 31.2 %) developed a paradoxical reaction. Twenty-seven patients developed hydrocephalus, 26 developed tuberculomas, 12 developed optochiasmatic arachnoiditis and 4 patients had spinal arachnoiditis. In 41 patients (out of 44) cerebrospinal fluid paradoxically worsened (increase in cells and/or protein); 2 demonstrated a decrease in cells with polymorph predominance while in one it was normal. In 3 patients, paradoxical cerebrospinal fluid changes were not associated with neuroimaging changes. On multivariate analysis, predictors of paradoxical reaction were female gender (p = 0.013), HIV positivity (p = 0.01) and a shorter duration of illness (p = 0.049). Development of paradoxical reactions did not predict the disability status of the patients.Conclusions: Paradoxical reaction occurs in approximately one-third of patients with tuberculous meningitis. Female gender, concomitant HIV infection, and a shorter duration of illness were significant predictors. Paradoxical reactions did not adversely affect the outcome.

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“…Once a tuberculous infection of the central nervous system is known, one study found that 17.8% of patients manifested with optochiasmal involvement. 18 However, central nervous system (CNS) involvement is only observed in 1-3% of tuburculous infections. Further, if properly treated with ethambutol, there are no known cases of development of tuberculoma in the CNS while already on therapy.…”

Section: Discussionmentioning

confidence: 99%

Spectrum and Clinical Course of Visual Field Abnormalities in Ethambutol Toxicity

Mendel

Fleischman

Allingham

et al. 2016

Neuro-Ophthalmology

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Visual toxicities from ethambutol are rare but represent one of the few causes of non-glaucomatous and non-compressive bitemporal hemianopsia. The authors present a six-patient case series illustrating variable clinical presentation and reversibility of visual loss in patients treated with ethambutol for Mycobacterium avium complex, including four patients who presented with visual field defects suggestive of bitemporal hemianopsia. Two additional patients were being followed for glaucoma, developed visual field defects with ethambutol treatment, and subsequently recovered with cessation of drug. In patients being treated with ethambutol, reversible bitemporal hemianopsia was the most commonly noted presentation of ethambutol toxicity. ARTICLE HISTORY

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Vision impairment in tuberculous meningitis: Predictors and prognosis

Cited by 62 publications

References 14 publications

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

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

Miliary Tuberculosis Mimicking Brain Metastasis from Renal Cell Carcinoma

Spectrum and Clinical Course of Visual Field Abnormalities in Ethambutol Toxicity

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