DR. RAMYA REDDY KEESARA

DR.ATHER MOHAMMED

Abstract

We herein bring to light a case report of vision loss due to opto-chiasmatic tuberculoma which developed post ATT (anti-tubercular therapy) in a Tuberculous meningitis (TBM) patient. A 21 year old female presented with no perception of light and RAPD in the RE and 6/12 vision in the LE with sluggish pupils. She had a medical history of TB meningitis, epilepsy and ATT use since 9 months. On investigating further she had LE temporal hemianopia and large pale discs with significant cupping and gross RNFL thinning in BE. Suprasellar ring enhancing lesions with co-existing ventricular dilation was evident on MRI. Chronic meningeal inflammation, mass effect of opto-chiasmatic tuberculoma/ hydrocephalus and ethambutol toxicity might have contributed to the visual damage. Threatening hydrocephalus even post ATT & diminished vision might necessitate surgical intervention however visual recovery remains uncertain. Baseline eye exam and follow ups shall be encouraged in TBM patients.