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Optochiasmatic tuberculomas: a vision-threatening paradoxical response in tuberculous meningitis

Nisar A Wani1, Naseer Khan, Tasleem Kosar

  • 1Sher-I-Kashmir Institute of Medical Sciences (SKIMS), Department of Radiology, Srinagar, India. nisar.wani@yahoo.com

Turkish Neurosurgery
|March 23, 2012
PubMed

Insights

Tuberculosis (TB) is a leading infectious disease killer. This case highlights rare optochiasmatic tuberculomas causing visual loss in a patient treated for tuberculous meningitis (TBM), emphasizing prompt diagnosis and steroid treatment.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Ophthalmology

Background:

  • Tuberculosis (TB) remains a major global health threat, particularly in developing nations.
  • Tuberculous meningitis (TBM) is a severe form of TB with significant morbidity and mortality.
  • Intracranial tuberculomas can paradoxically develop during antituberculous therapy.

Observation:

  • Optochiasmatic tuberculomas are a rare complication of TBM, potentially causing severe visual impairment.
  • A 56-year-old male on first-line antituberculous drugs developed visual impairment 2 months into treatment.
  • MRI revealed multiple perichiasmatic and parenchymal ring-enhancing lesions consistent with tuberculomas.

Findings:

  • The patient's visual impairment was attributed to rare optochiasmatic tuberculomas.
  • Prompt treatment with corticosteroids alongside continued antituberculous therapy led to gradual vision recovery.
  • This case underscores the importance of considering rare complications during TB treatment.

Implications:

  • Visual impairment in patients on antituberculous drugs warrants suspicion of optochiasmatic tuberculomas.
  • Urgent contrast-enhanced MRI is crucial for diagnosing these rare lesions.
  • Early steroid intervention is vital for preserving vision in such cases.

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