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Intracranial tuberculoma presenting as an isolated oculomotor nerve paresis

Michael Gottlieb1, Alexander Kogan1, Deborah Kimball1

  • 1Department of Emergency Medicine, Cook County Hospital, Chicago, Illinois.

The Journal of Emergency Medicine
|December 3, 2014
PubMed
Abstract

Insights

Intracranial tuberculosis (TB) can mimic other serious conditions by causing isolated oculomotor nerve paresis. Prompt diagnosis and treatment of this rare presentation are vital for patient recovery.

Area of Science:

  • Neurology
  • Infectious Diseases

Background:

  • Isolated oculomotor nerve paresis has a broad differential diagnosis, including life-threatening conditions.
  • Intracranial tuberculosis (TB) is a rare but serious cause of neurological deficits, associated with high morbidity and mortality.

Observation:

  • A 46-year-old male presented with 5 days of diplopia, right inferolateral exotropia, and medial rectus weakness.
  • Brain CT revealed a midbrain ring-enhancing lesion with edema, causing mass effect on the cerebral aqueduct.

Findings:

  • Tuberculosis (TB) was identified as the etiology of the intracranial lesion.
  • The patient's symptoms improved with steroids and a four-drug anti-TB regimen.

Implications:

  • Intracranial tuberculomas can present atypically with isolated oculomotor nerve palsy, even without systemic symptoms.
  • Emergency physicians must consider a wide differential diagnosis for oculomotor nerve paresis to ensure timely identification of critical conditions like intracranial TB.
Keywords:
cranial nerve 3cranial nerve IIIextrapulmonary tuberculomaintracerebral tuberculomaintracranial tuberculomaoculomotor nervetuberculosis

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