Title: Isolated 3rd Nerve Palsy Presenting in a Background of Multiple Cerebellar Tuberculoma with Tubercular Meningitis
Author: Dr Milan Chhetri
DOI: https://dx.doi.org/10.18535/jmscr/v11i1.02
Abstract
Tuberculous meningitis (TB meningitis) is a subacute or chronic meningitis with diverse manifestations. Isolated oculomotor nerve palsy and with multiple cerebellar tuberculomas as initial manifestation is rare and uncommon.
We report a rare case of oculomotor nerve palsy associated with multiple cerebellar and cerebral tuberculous granuloma associated with mild meningoencephalitis
A 25-year-old male was brought to the emergency department in a mild confusional state with short 2 days history of fever. He also gave a history on one episode of convulsion.
Clinical examination revealed isolated left-sided 3rd nerve palsy with complete ptosis diplopia and anisocoria with mild meningism.
Subsequently His reports-GAD-CONTRAST MRI WITH SPECTROSCOPY with MRI-Spectroscopic peaks of lipids strongly indicated tubercular etiology.
spinal fluid was appropriately tubercular in nature
He was immediately started on 4 anti-tuberculous drugs regimes and anti-epileptics
He became normally oriented with resolution of 3rd nerve palsy and seizure free within 3-4 weeks of therapy.
Patients with tuberculosis meningitis presents with abrupt onset oculomotor nerve palsy, rapid diagnosis should be undertaken and proper treatment initiated, as outcome and prognosis is time dependent.
