Garg Ravindra Kumar, Malhotra Hardeep Singh, Kumar Neeraj, Uniyal Ravi
Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India.
Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India.
J Neurol Sci. 2017 Apr 15;375:27-34. doi: 10.1016/j.jns.2017.01.031. Epub 2017 Jan 10.
Vision loss is a disabling complication of tuberculous meningitis. Approximately, 15% of survivors are either completely or partially blind. All structures of the visual pathway may be affected in tuberculous meningitis. Optic nerve and optic chiasma are most frequently and dominantly affected. Thick-gelatinous exudates lying over the base of brain, are the pathological hallmark of tuberculous meningitis and are responsible for almost all of its major complications, including vision loss. Strangulation of optic nerves and optic chiasma by the exudates, compression over optic chiasma by the dilated third ventricle, raised intracranial pressure, endarteritis, shunt failure, bacterial invasion of optic nerves and drug-induced optic nerve damage are important reasons that are considered responsible for vision loss. Prompt antituberculosis treatment is the best management option available. Immunomodulatory drugs and cerebrospinal fluid diversion procedures are of limited help. Early recognition and treatment of tuberculous meningitis is the only way forward to tackle this problem.
视力丧失是结核性脑膜炎的一种致残性并发症。大约15%的幸存者会完全或部分失明。结核性脑膜炎可累及视觉通路的所有结构。视神经和视交叉最常且主要受累。位于脑底部的厚凝胶状渗出物是结核性脑膜炎的病理标志，几乎导致其所有主要并发症，包括视力丧失。渗出物对视神经和视交叉的绞窄、扩张的第三脑室对视交叉的压迫、颅内压升高、动脉内膜炎、分流失败、细菌对视神经的侵袭以及药物性视神经损伤是被认为导致视力丧失的重要原因。及时进行抗结核治疗是现有的最佳治疗选择。免疫调节药物和脑脊液分流手术的帮助有限。早期识别和治疗结核性脑膜炎是解决这一问题的唯一途径。
