title: Vision impairment in tuberculous meningitis: predictors and prognosis.
abstract: BACKGROUND
  Vision impairment is a devastating complication of tuberculous meningitis. In the present study we evaluated the predictors and prognostic significance of vision impairment in tuberculous meningitis.
  
  
  METHODS
  In this study, 101 adult patients with tuberculous meningitis were evaluated for vision status and physical disability and were followed up for 6 months. Contrast enhanced magnetic resonance imaging (MRI) was performed at baseline and 6 months.
  
  
  RESULTS
  Out of 101 patients, 74 patients had normal vision and 27 patients had low vision or blindness at enrollment. Thirteen patients died during the study period. Out of 88 patients who survived at 6 months, 68 patients had good vision, 11 patients had low vision and 9 patients had blindness. Predictors of vision deterioration were papilledema, cranial nerve palsies, raised cerebrospinal fluid protein (>1g/L), and presence of optochiasmatic arachnoiditis in MRI. Predictors of blindness, at 6 months, were found to be papilledema, vision acuity < or =6/18, cranial nerve palsies, tuberculous meningitis stage II or III, raised cerebrospinal fluid protein (>1g/L), optochiasmatic arachnoiditis, and optochiasmal tuberculoma. At 6 months, 27 patients had death or severe disability. Predictors of death or severe disability at 6 months were vision acuity < or =6/18, cranial nerve deficits, hemiparesis, clinical stage II or III, and presence of infarct in MRI.
  
  
  CONCLUSIONS
  Vision impairment occurred in one-fourth of patients with tuberculous meningitis. Principal causes of vision loss were optochiasmatic arachnoiditis and optochiasmal tuberculoma. Impaired vision predicted death or severe disability.
authors.affiliation: Department of Neurology, Chhatrapati Shahuji Maharaj Medical University, Uttar Pradesh, Lucknow, India.
authors.forename: Manish Kumar
authors.initials: MK
authors.lastname: Sinha
authors.forename: Ravindra Kumar
authors.initials: RK
authors.lastname: Garg
authors.lastname: Anuradha Hk
authors.forename: Atul
authors.initials: A
authors.lastname: Agarwal
authors.forename: Maneesh Kumar
authors.initials: MK
authors.lastname: Singh
authors.forename: Rajesh
authors.initials: R
authors.lastname: Verma
authors.forename: Rakesh
authors.initials: R
authors.lastname: Shukla
mesh_terms: D000328:Adult; D001099:Arachnoid / Q000473:pathology / Q000503:physiopathology; D001921:Brain / Q000473:pathology / Q000503:physiopathology; D002556:Cerebrospinal Fluid Proteins / Q000032:analysis / Q000378:metabolism; D003389:Cranial Nerve Diseases / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D003941:Diagnostic Techniques, Ophthalmological; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D015835:Ocular Motility Disorders / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D009897:Optic Chiasm / Q000473:pathology / Q000503:physiopathology; D009900:Optic Nerve / Q000473:pathology / Q000503:physiopathology; D010211:Papilledema / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D012720:Severity of Illness Index; D016862:Tuberculoma, Intracranial / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D014390:Tuberculosis, Meningeal / Q000150:complications*; D014786:Vision Disorders / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology; D014787:Vision Tests; D055815:Young Adult
chemical_list: D002556:Cerebrospinal Fluid Proteins