Tuberculous meningitis-related optic neuritis: Recovery of vision with thalidomide in 4 consecutive cases
Date
2010
Authors
Schoeman J.F.
Andronikou S.
Stefan D.C.
Freeman N.
Van Toorn R.
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Abstract
Blindness is an uncommon but devastating complication of tuberculosis meningitis. The main causes are chronically raised intracranial pressure (hydrocephalus and/or tuberculomas) or direct involvement of the optic chiasm or optic nerves by the basal arachnoiditis (inflammation and/or compression). Antituberculosis therapy combined with corticosteroids and control of intracranial pressure constitutes the mainstay of therapy for tuberculous meningitis. Despite these treatment measures, some patients develop blindness, mainly as a result of progressive optochiasmatic arachnoiditis. This led us to explore the role of adjuvant thalidomide therapy, and we describe the dramatic recovery of vision in 4 consecutive cases. Clinical recovery was accompanied by marked radiological improvement on magnetic resonance imaging (MRI) of the brain. © The Author(s) 2010.
Description
Keywords
acetylsalicylic acid, antibiotic agent, ceftriaxone, ethionamide, isoniazid, prednisone, pyrazinamide, rifampicin, thalidomide, tuberculostatic agent, absence of side effects, acute lymphoblastic leukemia, add on therapy, adjuvant therapy, arachnoiditis, article, bacterial meningitis, bone marrow biopsy, brain, brain infarction, brain ventricle peritoneum shunt, case report, cerebrospinal fluid cytology, child, clinical examination, computer assisted tomography, convalescence, disease association, disease severity, drug efficacy, electroretinogram, enzyme linked immunosorbent assay, eye examination, female, human, hydrocephalus, lung tuberculosis, male, meningitis, muscle stiffness, neuroimaging, noncommunicating hydrocephalus, nuclear magnetic resonance imaging, nystagmus, optic chiasm arachnoiditis, optic neuritis, otorrhea, papilledema, preschool child, priority journal, school child, thorax radiography, thrombosis, treatment duration, treatment outcome, tuberculous meningitis, vision, visual acuity, visual impairment, Antitubercular Agents, Brain, Child, Child, Preschool, Drug Therapy, Combination, Female, Humans, Magnetic Resonance Imaging, Male, Optic Neuritis, Recovery of Function, Thalidomide, Treatment Outcome, Tuberculosis, Meningeal, Vision, Ocular
Citation
Journal of Child Neurology
25
7
25
7