title: Optochiasmatic tuberculomas: a vision-threatening paradoxical response in tuberculous meningitis.
abstract: The single main cause of death from infectious diseases worldwide is     tuberculosis, which is more prevalent in developing countries. Tuberculous     meningitis (TBM) is a severe form of TB in which morbidity and mortality depend     upon the stage of presentation. Intracranial brain parenchymal tuberculomas may     form paradoxically, days to months after starting antituberculous drug therapy.     Tuberculomas may develop in and around he optic chiasm and optic nerves after     institution of antituberculous treatment as a quite rare occurrence in TBM; this     may lead to severe visual loss if not treated properly. We describe a     56-year-old man with documented TBM being treated with first line     antituberculous drugs who developed visual impairment 2 months after starting     the treatment. MRI after gadolinium administration revealed multiple     perichiasmatic and a few parenchymal ring enhancing lesions due to tuberculomas.     The patient was treated with corticosteroids and antituberculous therapy was     continued after which he recovered his vision gradually. Visual impairment     developing in a patient on treatment with antituberculous drugs should give rise     to a suspicion of rare optochiasmatic tuberculomas; this necessitates urgent     contrast-enhanced MRI of the brain and prompt treatment with steroids.
authors.affiliation: Sher-I-Kashmir Institute of Medical Sciences (SKIMS), Department of Radiology, Srinagar, India. nisar.wani@yahoo.com
authors.forename: Nisar A
authors.initials: NA
authors.lastname: Wani
authors.forename: Naseer
authors.initials: N
authors.lastname: Khan
authors.forename: Tasleem
authors.initials: T
authors.lastname: Kosar
authors.forename: Abdul
authors.initials: A
authors.lastname: Qayum
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009897:Optic Chiasm / Q000382:microbiology* / Q000473:pathology; D016862:Tuberculoma, Intracranial / Q000188:drug therapy / Q000473:pathology*; D014390:Tuberculosis, Meningeal / Q000188:drug therapy / Q000473:pathology*; D014786:Vision Disorders / Q000382:microbiology* / Q000473:pathology
chemical_list: D000305:Adrenal Cortex Hormones; D000995:Antitubercular Agents