Clinical characteristics of tuberculous meningitis combined with cranial nerve palsy

To retrospectively analyze the data of 72 patients with tuberculous meningitis (TBM) combined with cranial nerve palsy, to explore the incidence, clinical features, CSF assay changes and outcome in patients with TBM.

A total of 72 patients were diagnosed as TBM with cranial nerve palsy. The gender, age, clinical manifestations, CSF examinations, cerebral magnetic resonance imaging (MRI) enhancement scan were collected. All these patients had completed at least 2 months of follow up after anti-tuberculous treatment.

This study retrospectively evaluated 486 patients; include 254 (52.3%) men and 232 (47.7%) women. The mean age was 35.2 ± 17.0 years. 72 patients (14.8%) were diagnosed as TBM with cranial nerve palsy. Among them, 38 cases (52.8%) had optic nerve palsy (the 2nd nerve), 41 cases (56.9%) had oculomotor nerve palsy (the 3rd nerve), 3 cases (4.2%) had abducens nerve palsy (the 6th nerve), and 10 cases (13.9%) had auditory nerve palsy (the 8th nerve). 16 patients (22.2%) had two groups of cranial nerve involvement (oculomotor nerve and optic nerve in 10 cases, optic nerve and auditory nerve in 5 cases, and optic nerve and abducens nerve in 1 case). Two patients (2.8%) had three groups of cranial nerve involvement (oculomotor nerve, optic nerve and abducens nerve). CSF MTB was detected by acid fast bacilli (no patient was positive), MTB DNA detection by multiplex polymerase chain reaction (PCR) (3 patients were positive) and MTB cultures (2 patients were positive). There was no significant difference of CSF cells and biochemistry investigations between the patients with or without cranial nerve palsy. Magnetic resonance imaging (MRI) enhancement scan were done in 66 (91.7%) patients after admission. It was abnormal in 57 (86.3%) patients. 15 cases (26.3%) had meningeral enhancement, 25 cases (43.9%) had tuberculoma, 11 cases (19.3%) had hydrocephalus and 6 cases (10.5%) with infarct. All patients were followed up after 2 months of anti-tuberculous treatment. 70 patients (97.2%, 70/72) with the cranial nerve palsy were fully recovered without obvious sequel.

The complications of cranial nerve palsy in TBM patients are not uncommon, and the rate of misdiagnosis is high, which makes them vulnerable to emergencies such as disturbance of consciousness. Effective anti-tuberculous treatment can restore most cranial nerve palsy.