Tuberculous meningitis-related optic neuritis: recovery of vision with thalidomide in 4 consecutive cases.
Blindness is an uncommon but devastating complication of tuberculosis meningitis. The main causes are chronically raised intracranial pressure (hydrocephalus and/or tuberculomas) or direct involvement of the optic chiasm or optic nerves by the basal arachnoiditis (inflammation and/or compression). Antituberculosis therapy combined with corticosteroids and control of intracranial pressure constitutes the mainstay of therapy for tuberculous meningitis. Despite these treatment measures, some patients develop blindness, mainly as a result of progressive optochiasmatic arachnoiditis. This led us to explore the role of adjuvant thalidomide therapy, and we describe the dramatic recovery of vision in 4 consecutive cases. Clinical recovery was accompanied by marked radiological improvement on magnetic resonance imaging (MRI) of the brain.
Schoeman
Johan F
JF
Department of Pediatrics and Child Health, Tygerberg Children's Hospital, Faculty of Health Sciences, University of Stellenbosch, Western Cape, South Africa. jfs@sun.ac.za
Andronikou
Savvas
S
Stefan
D Christina
DC
Freeman
Nicola
N
van Toorn
Ronald
R
D000995:Antitubercular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001921:Brain / Q000187:drug effects / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009902:Optic Neuritis / Q000150:complications* / Q000188:drug therapy* / Q000473:pathology; D020127:Recovery of Function / Q000187:drug effects; D013792:Thalidomide / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome; D014390:Tuberculosis, Meningeal / Q000150:complications* / Q000188:drug therapy* / Q000473:pathology; D014785:Vision, Ocular
D000995:Antitubercular Agents; D013792:Thalidomide