Neuro-ophthalmic features in pediatric tubercular meningoencephalitis.
OBJECTIVE
To examine the neuro-ophthalmic profile in childhood tubercular meningoencephalitis and assess its prognostic importance.


METHODS
One hundred consecutive patients with tubercular meningoencephalitis underwent evaluation for optic nerve functions, supra- and infranuclear oculomotor involvement, and raised intracranial tension. Patients underwent follow-up for 9 months.


RESULTS
In 100 patients with tubercular meningoencephalitis, 67 had neuro-ophthalmic features. Common findings were retrobulbar neuritis (32) and gaze palsy (20). Others, in decreasing prevalence, were third and sixth nerve palsy, conjugate deviation, primary optic atrophy, and complete ophthalmoplegia. Raised intracranial tension was associated with neuro-ophthalmic features in 53 of 67 patients (P<.05). Complete ophthalmoplegia was significantly associated with mortality on logistic regression analysis (relative risk, 6.35; P=.012). By 6 months, 56% of patients with retrobulbar neuritis progressed to optic atrophy.


CONCLUSIONS
Neuro-ophthalmic features, in association with raised intracranial tension, often are a part of pediatric tubercular meningoencephalitis presentation. The type of neuro-ophthalmic features may have prognostic value. Optic nerve involvement is the most common finding in tubercular meningoencephalitis.
Amitava
A K
AK
Institute of Ophthalmology, Jawaharlal Nehru Medical College, Aligarh Muslim University, India.
Alarm
S
S
Hussain
R
R
D002648:Child; D002675:Child, Preschool; D005128:Eye Diseases / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019586:Intracranial Hypertension / Q000175:diagnosis; D007427:Intracranial Pressure; D008297:Male; D009901:Optic Nerve Diseases / Q000175:diagnosis*; D012307:Risk Factors; D014390:Tuberculosis, Meningeal / Q000175:diagnosis*