Paradoxical Growth of Optochiasmatic Tuberculoma during the Treatment of Tuberculous Meningitis

Authors

  • Arjan Idrizaj

Abstract

Tuberculosis (TB) is the 7th leading cause of death and disability worldwide and has reached epidemic proportions in both developed and undeveloped nations. Approximately 5 to 10% of tuberculosis cases involve the brain and central nervous system. Tuberculomas account for 10 to 30% of intracranial (IC) masses in TB-endemic areas. The clinical and neuroimaging features of tuberculoma are variable and may pose a diagnostic challenge in the absence of systemic TB or tuberculous meningitis. Intracranial brain parenchymal tuberculomas may form paradoxically, days to months after starting antituberculous drug therapy. Tuberculomas may develop in and around 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 5 year-old child with documented TBM being treated with first line antituberculous drugs which developed visual impairment 3 months after starting the treatment. MRI after gadolinium administration revealed multiple perichiasmatic ring enhancing lesions due to tuberculomas. We recommended a treatment with corticosteroids and antituberculous therapy. 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.

Keywords: Optochiasmatic tuberculoma, Paradoxical response, Tuberculous meningitis, Tuberculoma, MRI, etc.

Downloads

Published

2015-12-31

How to Cite

Idrizaj, A. (2015). Paradoxical Growth of Optochiasmatic Tuberculoma during the Treatment of Tuberculous Meningitis. ANGLISTICUM. Journal of the Association-Institute for English Language and American Studies, 3(6), 177–181. Retrieved from https://anglisticum.org.mk/index.php/IJLLIS/article/view/471

Issue

Vol. 3 No. 6 (2014): Volume 3, No.6, June, 2014

Section

Volume 3, No.6, June, 2014

License

Declaration/Copyright transfer:

1. In consideration of the undertaking set out in paragraph 2, and upon acceptance by ANGLISTICUM for publication of the manuscript in the Journal, I/We hereby assign and transfer publication rights to ANGLISTICUM, whereas I/We retain the copyright for the manuscript. This assignment provides ANGLISTICUM the sole right and responsibility to publish the manuscript in its printed and online version, and/or in other media formats.

2. In consideration of this assignment, ANGLISTICUM hereby undertakes to prepare and publish the manuscript in the Journal, subject only to its right to refuse publication if there is a breach of the Author’s warranty in paragraph 4 or if there are other reasonable grounds.

3. Editors and the editorial board of ANGLISTICUM are empowered to make such editorial changes as may be necessary to make the Manuscript suitable for publication.

4. I/We hereby acknowledge that: (a) The manuscript submitted is an original work and that I/We participated in the work substantively and thus I/We hereby are prepared to take public responsibility for the work; (b) I/We hereby have seen and approved the manuscript as submitted and that the manuscript has not either been published, submitted or considered for publication elsewhere; (c) The text, illustration, and any other materials included in the manuscript do not infringe upon any existing copyright or other rights of anyone.

5. I/We hereby indemnify ANGLISTICUM and the respective Editors of the Journal as mentioned in paragraph 3, and hold them harmless from any loss, expense or damage occasioned by a claim or suit by a third party for copyright infringement, or any suit arising out of any breach of the foregoing warranties as a result of publication of the manuscript.