title: An unusual cause of visual impairment in tuberculous meningitis.
abstract: Impairment of vision is a devastating complication of tuberculous meningitis which may occur as a result of increased intracranial pressure, compression over the visual pathways or vasculitis. We herein present occurrence of neuroretinitis in a 35-year-old lady presenting with low grade fever and headache for one month, and associated with diminution of vision from 3 weeks. She was diagnosed as a case of definite tuberculous meningitis and initiated on anti-tuberculous treatment as per WHO guidelines with supplemental corticosteroids. Marked improvement in vision was observed and at 3 months of follow-up the patient was asymptomatic. Direct ophthalmoscopy, visual field analysis, fluorescein angiography, optical coherence tomography and magnetic resonance imaging of the brain were done to document the ophthalmological findings. Neuroretinitis, being an unusual cause of visual impairment in tuberculous meningitis, must be considered in patients without any evidence of raised intracranial pressure or compression, and with normal fluorescein angiography. We suggest that neuroretinitis may be added to list of causes of visual impairment in patients with tuberculous meningitis.
authors.affiliation: Department of Neurology, Chhatrapati Shahuji Maharaj Medical University, Lucknow, Uttar Pradesh, India. drhsmalhotra@gmail.com
authors.forename: Hardeep Singh
authors.initials: HS
authors.lastname: Malhotra
authors.forename: Ravindra Kumar
authors.initials: RK
authors.lastname: Garg
authors.forename: Arvind
authors.initials: A
authors.lastname: Gupta
authors.forename: Sandeep
authors.initials: S
authors.lastname: Saxena
authors.forename: Aloy
authors.initials: A
authors.lastname: Majumdar
authors.forename: Amita
authors.initials: A
authors.lastname: Jain
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D003907:Dexamethasone / Q000627:therapeutic use; D005260:Female; D006801:Humans; D012173:Retinitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D016896:Treatment Outcome; D014390:Tuberculosis, Meningeal / Q000150:complications* / Q000188:drug therapy; D014786:Vision Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*
chemical_list: D000995:Antitubercular Agents; D003907:Dexamethasone