Bilateral Complete Oculomotor Palsy in Tubercular Meningitis

Gaba, Saurabh; Gupta, Monica; Lamba, Amtoj Singh; Bhardwaj, Arshia; Gupta, Harsheel

doi:10.7759/cureus.11001

Cited by 3 publications

(6 citation statements)

References 13 publications

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Section: Discussionmentioning

confidence: 99%

“…We reviewed 16 cases of pathogenic negative tuberculous meningitis since 2020 [ 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ] (see Supplementary Table S4 ). These case reports are similar to our cases, mainly because of their atypical clinical manifestations or lesion sites, such as one-and-a-half syndrome [ 35 ], nonconvulsive status epilepticus [ 36 ], oculomotor palsy [ 38 ], lesions involving clivus [ 31 ], and midbrain [ 32 ]. Although there was no etiological diagnostic evidence, clinicians highly suspected tuberculous meningitis based on the general symptoms of tuberculosis, CSF examination, and imaging findings, and began empirical ATT treatment, which ultimately led to a good clinical outcome for most patients.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical Management of Pathogen-Negative Tuberculous Meningitis in Adults: A Series Case Study

Huang

et al. 2022

JCM

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Tuberculosis remains a serious world public health problem. Tuberculous meningitis (TBM) is the one of most severe forms of extrapulmonary tuberculosis. However, the insensitivity and time-consuming requirement of culturing the pathogen Mycobacterium tuberculosis, the traditional “gold standard” diagnostic test for TBM, often delays timely diagnosis and treatment, resulting in high disability and mortality rates. In our series case study, we present five pathogen-negative TBM cases who received empirical anti-tuberculosis therapy with a good clinical outcome. We describe in detail the clinical symptoms, laboratory test results, and imaging findings of the five patients from symptom onset to dynamic follow-up. We then summarize the similarities of the clinical characteristics of the presented patients, as well as shared features in laboratory and imaging tests, and proceed to analyze the challenges in the timely diagnosis of TBM. Finally, we argue that monitoring of cerebrospinal fluid markers and imaging are critical for the diagnosis and treatment of TBM, and emphasize the importance of differential diagnosis in cases when tuberculous meningitis is highly suspected despite negative findings for that etiology.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical Management of Pathogen-Negative Tuberculous Meningitis in Adults: A Series Case Study

Huang

et al. 2022

JCM

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“…63 In rare cases, isolated bilateral oculomotor nerve palsy in TBM may occur. 65 MRI shows thickening and enhancement on postcontrast imaging of the affected cranial nerves, in particular along the cisternal course of the nerves within the basal cisterns or within the internal auditory canal. Fat-saturated T1W sequences as well as contrast-enhanced FLAIR imaging are known to increase lesion conspicuity.…”

Section: Ademmentioning

confidence: 99%

“…In most cases, multiple cranial nerves are involved 63 . In rare cases, isolated bilateral oculomotor nerve palsy in TBM may occur 65 . MRI shows thickening and enhancement on post‐contrast imaging of the affected cranial nerves, in particular along the cisternal course of the nerves within the basal cisterns or within the internal auditory canal.…”

Section: Specific Issues When Diagnosing Cns Tb and The Role Of Mrimentioning

confidence: 99%

Pediatric and adult meningeal, parenchymal, and spinal tuberculosis: A neuroimaging review

Mertiri,

Freiling,

Desai

et al. 2023

Journal of Neuroimaging

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Neurotuberculosis is defined as a tuberculous infection of the meninges, brain parenchyma, vessels, cranial and spinal nerves, spinal cord, skull, and spine that can occur either in a localized or in a diffuse form.It is a heterogeneous disease characterized by many imaging appearances and it has been defined as “the great mimicker” due to similarities with many other conditions.The diagnosis of central nervous system (CNS) tuberculosis (TB) is based on clinical presentation, neuroimaging findings, laboratory and microbiological findings, and comprehensive evaluation of the response to anti‐TB drug treatment.However, the absence of specific symptoms, the wide spectrum of neurological manifestations, the myriad of imaging findings, possible inconclusive laboratory results, and the paradoxical reaction to treatment make the diagnosis often challenging and difficult, potentially delaying adequate treatment with possible devastating short‐term and long‐term neurologic sequelae.Familiarity with the imaging characteristics helps in accurate diagnosis and may prevent or limit significantly morbidity and mortality. The goal of this review is to provide a comprehensive up‐to‐date overview of the conventional and advanced imaging features of CNS TB for radiologists, neuroradiologists, and pediatric radiologists. We discuss the most typical neurotuberculosis imaging findings and their differential diagnosis in children and adults with the goal to provide a global overview of this entity.

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“…El 20-30% desarrollan formas extrapulmonares, siendo la afectación del sistema nervioso central (SNC) una de las formas con peor pronóstico. 1,2 Es de destacar que la vacuna BCG ha demostrado una eficacia de entre 64 -100% para prevenir las formas meníngea y diseminada. Dicha eficacia es mayor en neonatos y desciende con el paso de los años.…”

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