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Optochiasmatic Tuberculosis

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Tuberculosis of the Central Nervous System

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Abstract

Optochiasmatic tuberculosis (TB) is a dreaded complication of TB of the central nervous system. Both optochiasmatic arachnoiditis and optochiasmatic tuberculoma lead to vision involvement and poor outcome. Commonly, optochiasmatic involvement is seen in stage III tuberculous meningitis with high cerebrospinal fluid proteins. Other complications like hydrocephalous, vasculitic stroke, and other cranial nerve deficits are common. Paradoxical involvement of optochiasmatic region can also occur and thus require close follow-up and constant vision monitoring. Treatment comprises continuation of anti-TB drugs with steroids that should be prolonged (often >8 weeks). Methylprednisolone and thalidomide have been used with good results. Other adjuvants like streptokinase, hyaluronidase, interferon, and infliximab have been used but not indicated in present times. Surgical intervention can be done if required as previous reports shows promising results. Further research and studies are required to reduce the morbidity associated with optochiasmatic TB. Prompt diagnosis and early treatment is the key to manage this dreaded complication.

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Abbreviations

CNS:

Central nervous system

CSF:

Cerebrospinal fluid

CT:

Computed tomography

EMB:

Ethambutol

IL:

Interleukin

INH:

Isoniazid

MMP:

Matrix metalloproteinases

OCA:

Optochiasmatic arachnoiditis

OCT:

Optochiasmatic tuberculoma

PAS:

Para-aminosalicylic sodium

PCEG:

Pneumocisterno-encephalography

PL:

Perception of light

RIF:

Rifampicin

RIHSA:

Radioactive human serum albumin

STR:

Streptomycin

TB:

Tuberculosis

TBM:

Tuberculous meningitis

TNF:

Tumor necrosis factor

WHO:

World Health Organization

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Authors and Affiliations

  1. Department of Neurology, King George’s Medical University, Lucknow, UP, India

    Neeraj Kumar MD, DM, Ravindra K. Garg MD, DM & Hardeep Singh Malhotra MD, DM

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  1. Neeraj Kumar MD, DM
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  2. Ravindra K. Garg MD, DM
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  3. Hardeep Singh Malhotra MD, DM
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Correspondence to Neeraj Kumar MD, DM .

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Editors and Affiliations

  1. Adnan Menderes University, School of Medicine, Aydın, Turkey

    Mehmet Turgut

  2. Mohammed V University in Rabat, Avicenne Military Hospital of Marrakech, Rabat, Morocco

    Ali Akhaddar

  3. Hacettepe University, School of Medicine, Ankara, Turkey

    Ahmet T. Turgut

  4. King George Medical University, Lucknow, Uttar Pradesh, India

    Ravindra K. Garg

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Kumar, N., Garg, R.K., Malhotra, H.S. (2017). Optochiasmatic Tuberculosis. In: Turgut, M., Akhaddar, A., Turgut, A., Garg, R. (eds) Tuberculosis of the Central Nervous System. Springer, Cham. https://doi.org/10.1007/978-3-319-50712-5_22

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  • DOI: https://doi.org/10.1007/978-3-319-50712-5_22

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