A Case of Oculomotor Nerve Palsy and Choroidal Tuberculous Granuloma Associated with Tuberculous Meningoencephalitis.
10.3341/kjo.2008.22.3.201
- Author:
Sunghyuk MOON
1
;
Junhyuk SON
;
Woohyok CHANG
Author Information
1. Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea. sjh@med.yu.ac.kr
- Publication Type:Case Report
- Keywords:
Choroidal tuberculous granuloma;
Oculomotor nerve palsy;
Ptosis;
Tuberculous meningoen-cephalitis
- MeSH:
Adolescent;
Antitubercular Agents/therapeutic use;
Blepharoptosis/diagnosis/drug therapy/microbiology;
Choroid Diseases/diagnosis/drug therapy/*microbiology;
Dexamethasone/therapeutic use;
Drug Therapy, Combination;
Ethambutol/therapeutic use;
Glucocorticoids/therapeutic use;
Humans;
Magnetic Resonance Imaging;
Male;
Meningoencephalitis/diagnosis/drug therapy/*microbiology;
Mycobacterium tuberculosis/*isolation & purification;
Oculomotor Nerve Diseases/diagnosis/drug therapy/*microbiology;
Perimetry;
Pyrazinamide/therapeutic use;
Radiography, Thoracic;
Tuberculoma/diagnosis/drug therapy/*microbiology;
Tuberculosis, Meningeal/diagnosis/drug therapy/*microbiology;
Tuberculosis, Ocular/diagnosis/drug therapy/microbiology;
Visual Fields
- From:Korean Journal of Ophthalmology
2008;22(3):201-204
- CountryRepublic of Korea
- Language:English
-
Abstract:
We report a rare case of oculomotor nerve palsy and choroidal tuberculous granuloma associated with tuberculous meningoencephalitis. A 15-year-old male visited our hospital for an acute drop of the left eyelid and diplopia. He has been on anti-tuberculous drugs (isoniazid, rifampin) for 1 year for his tuberculous encephalitis. A neurological examination revealed a conscious clear patient with isolated left oculomotor nerve palsy, which manifested as ptosis, and a fundus examination revealed choroidal tuberculoma. Other anti-tuberculous drugs (pyrazinamide, ethambutol) and a steroid (dexamethasone) were added. After 3 months on this medication, ptosis of the left upper eyelid improved and the choroidal tuberculoma decreasedin size, but a right homonymous visual field defect remained. When a patient with tuberculous meningitis presents with abrupt onset oculomotor nerve palsy, rapid re-diagnosis should be undertaken and proper treatment initiated, because the prognosis is critically dependent on the timing of adequate treatment.
