Department of Neurology, Chhatrapati Shahuji Maharaj Medical University, Lucknow, Uttar Pradesh, India.
J Neurol Sci. 2012 Jul 15;318(1-2):174-7. doi: 10.1016/j.jns.2012.04.001. Epub 2012 Apr 26.
Impairment of vision is a devastating complication of tuberculous meningitis which may occur as a result of increased intracranial pressure, compression over the visual pathways or vasculitis. We herein present occurrence of neuroretinitis in a 35-year-old lady presenting with low grade fever and headache for one month, and associated with diminution of vision from 3 weeks. She was diagnosed as a case of definite tuberculous meningitis and initiated on anti-tuberculous treatment as per WHO guidelines with supplemental corticosteroids. Marked improvement in vision was observed and at 3 months of follow-up the patient was asymptomatic. Direct ophthalmoscopy, visual field analysis, fluorescein angiography, optical coherence tomography and magnetic resonance imaging of the brain were done to document the ophthalmological findings. Neuroretinitis, being an unusual cause of visual impairment in tuberculous meningitis, must be considered in patients without any evidence of raised intracranial pressure or compression, and with normal fluorescein angiography. We suggest that neuroretinitis may be added to list of causes of visual impairment in patients with tuberculous meningitis.
视力损害是结核性脑膜炎的一种严重并发症，可能是由于颅内压增高、视觉通路受压或血管炎引起的。我们在此介绍了一位 35 岁女性患者的病例，她因低热和头痛持续一个月就诊，伴有视力下降 3 周。她被诊断为明确的结核性脑膜炎，并按照世界卫生组织的指南开始进行抗结核治疗，并辅以皮质类固醇。视力明显改善，随访 3 个月时患者无症状。进行了直接检眼镜检查、视野分析、荧光素血管造影、光学相干断层扫描和脑部磁共振成像，以记录眼科发现。神经视网膜炎是结核性脑膜炎导致视力损害的不常见原因，对于没有颅内压升高或压迫证据且荧光素血管造影正常的患者，必须考虑这种原因。我们建议将神经视网膜炎添加到结核性脑膜炎患者视力损害的原因列表中。
