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.
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
Johan F
JF
Schoeman
Savvas
S
Andronikou
D Christina
DC
Stefan
Nicola
N
Freeman
Ronald
R
van Toorn
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