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IMAGES IN MEDICINE  
Year : 2014  |  Volume : 6  |  Issue : 2  |  Page : 89
Tuberculous optochiasmatic arachnoiditis


Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India

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Date of Web Publication7-May-2014
 

How to cite this article:
Verma R, Patil TB, Lalla R. Tuberculous optochiasmatic arachnoiditis. J Global Infect Dis 2014;6:89

How to cite this URL:
Verma R, Patil TB, Lalla R. Tuberculous optochiasmatic arachnoiditis. J Global Infect Dis [serial online] 2014 [cited 2019 Aug 21];6:89. Available from: http://www.jgid.org/text.asp?2014/6/2/89/132057


A 25-year-old man was admitted with fever, headache, vomiting and vision loss for 2 months. Clinical examination revealed neck stiffness, inability to perceive projection of light and papilledema. Magnetic resonance imaging (MRI) of brain showed nodular thickening of basal meninges with contrast enhancement and multiple ring-enhancing lesions [Figure 1] and [Figure 2]. Cerebrospinal fluid was suggestive of tubercular meningitis with positive polymerase chain reaction for tuberculosis (TB-PCR).
Figure 1: (a) MRI T1-weighted image showing diffuse hypointensities involving bilateral internal and external capsules, thalamus, medial temporal and brainstem, (b, c) hyperintensities on T2w MRI in corresponding regions; and (d) fluid accentuated inversion recovery (FLAIR) sequence

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Figure 2: (a) MRI brain with contrast (axial) showing multiple enhancing lesions (tuberculoma) with meningeal enhancement and with dilation of temporal horns of third ventricle suggestive of hydrocephalus; (b) meningeal enhancement and exudates in quadrigeminal cistern; (c) spoiled gradient recall echo (SPGR) showing meningeal enhancement with exudates; (d) coronal SPGR showing meningeal enhancement along Sylvian fissure; and (e) MRI sagittal T1 contrast image showing contrast enhancing lesions in basifrontal, mid brain tectum and ventral Pons along with enhancement of basal meninges

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Tuberculous meningitis predominantly affects basal regions of brain, causing accumulation of exudates in suprasellar, Sylvian and interpeduncular cisterns, manifesting as optochiasmatic arachnoiditis (OCA). [1] It usually occurs in young individuals and causes slowly progressive vision loss. [2]

 
   References Top

1.Garg RK, Paliwal V, Malhotra HS. Tuberculous optochiasmatic arachnoiditis: A devastating form of tuberculous meningitis. Expert Rev Anti Infect Ther 2011;9:719-29.   Back to cited text no. 1
    
2.Anupriya A, Sunithi M, Maya T, Goel M, Alexander M, Aaron S, et al. Tuberculous optochiasmatic arachnoiditis. Neurol India 2010;58:732-5.  Back to cited text no. 2
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Correspondence Address:
Dr. Tushar B Patil
Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-777X.132057

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2008 Journal of Global Infectious Diseases | Published by Wolters Kluwer - Medknow
Online since 10th December, 2008