A case of oculomotor nerve palsy and choroidal tuberculous granuloma associated with tuberculous meningoencephalitis.
We report a rare case of oculomotor nerve palsy and choroidal tuberculous granuloma associated with tuberculous meningoencephalitis. A 15-year-old male visited our hospital for an acute drop of the left eyelid and diplopia. He has been on anti-tuberculous drugs (isoniazid, rifampin) for 1 year for his tuberculous encephalitis. A neurological examination revealed a conscious clear patient with isolated left oculomotor nerve palsy, which manifested as ptosis, and a fundus examination revealed choroidal tuberculoma. Other anti-tuberculous drugs (pyrazinamide, ethambutol) and a steroid (dexamethasone) were added. After 3 months on this medication, ptosis of the left upper eyelid improved and the choroidal tuberculoma decreasedin size, but a right homonymous visual field defect remained. When a patient with tuberculous meningitis presents with abrupt onset oculomotor nerve palsy, rapid re-diagnosis should be undertaken and proper treatment initiated, because the prognosis is critically dependent on the timing of adequate treatment.
Moon
Sunghyuk
S
Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea.
Son
Junhyuk
J
Chang
Woohyok
W
D000293:Adolescent; D000995:Antitubercular Agents / Q000627:therapeutic use; D001763:Blepharoptosis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D015862:Choroid Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D003907:Dexamethasone / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004977:Ethambutol / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008590:Meningoencephalitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D015840:Oculomotor Nerve Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D011718:Pyrazinamide / Q000627:therapeutic use; D013902:Radiography, Thoracic; D014375:Tuberculoma / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D014390:Tuberculosis, Meningeal / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D014392:Tuberculosis, Ocular / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D058609:Visual Field Tests; D014794:Visual Fields
D000995:Antitubercular Agents; D005938:Glucocorticoids; D011718:Pyrazinamide; D003907:Dexamethasone; D004977:Ethambutol
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