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IP Indian Journal of Neurosciences


Tuberculous optochiasmatic arachnoiditis – A prospective study


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Author Details: Uma Maheswari E,R M. Bhoopathy,M Jawahar*

Volume : 5

Issue : 1

Online ISSN : 2581-916X

Print ISSN : 2581-8236

Article First Page : 17

Article End Page : 19


Abstract

Introduction: Visual loss due to tuberculous optochiasmatic arachnoiditis (OCA) is one of the devastating complication tuberculous meningitis. The inflammatory exudates in tuberculous meningitis have a strong prediction to the basal cisterns of the brain resulting in OCA. The commonly ascribed causes of visual impairment in tuberculous meningitis are direct involvement n of the visual pathway structures (optic nerve, choroid, retina and retinal vasculature), optochiasmatic arachnoiditis, optic nerve granuloma, increased intracranial pressure and ethambutol toxicity. Apart from tuberculosis other causes for OCA are sarcoidosis, neurocysticercosis and trauma.
Aim This study evaluates the clinical, demographic profile, biochemical parameters, imaging profile, severity of visual impairment and response to treatment, and its predictors in OCA patients.
Materials and Methods: The patients who were admitted with TBM (Tuberculous meningitis) in the neurology wards and medical wards of a tertiary care hospital were evaluated for the occurrence of this complication and only those patients were enrolled in the study. Of the TBM (n= 78), 15.38% (n=12) patients developed TCA. They developed impairment of vision at a presentation during admission or during the course of illness.
Results: Analysis revealed that the affected were predominately females (n=9, 75%) and especially postnatal women. Assessment of clinical severity of TBM (done by MRC grading) showed that 7 patients (58.33%) were in stage III illness, 5 patients (41.66%) in stage II illness. On the clinical assessment of visual acuity 83% were blind (by Indian def. of visual acuity), and 17% had lesser grades of visual impairment. Those who were legally blind had cerebrospinal fluid (CSF) protein more than 500mg/dl. Analysis of the images showed that apart from exudates in the basal cistern, there was evidence of other associated complications.
Conclusion: This study reveals that the occurrence of optochiasmatic arachnoiditis in patients with TBM has to be predicted in the age group (20-25), female sex, postpartum women, patients in stage II, stage III illness, significantly elevated CSF (cerebrospinal fluid) proteins (> 500mg/dl), The affected patients showed a poor response to treatment.

Keywords: OCA - Tuberculous Optochiasmatic arachnoiditis, TBM - Tuberculous meningitis CSF – cerebrospinal fluid.