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Tuberculous meningitis: presenting as isolated complete III nerve palsy

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Int J Med Res Health Sci. |

Authors: Laul Rohit S , Avhad Vinod, Laul Abhishek S, Laul Subodh S
Int J Med Res Health Sci. 2013;2(4):981-984 |   DOI:10.5958/j.2319-5886.2.4.159

ABSTRACT

Tuberculous meningitis (TBM) is the most common form of central nervous system tuberculosis (TB) and has very high morbidity and mortality. TBM is a subacute disease with symptoms that may persist for weeks before diagnosis. Based on the clinical features alone, the diagnosis of TBM can neither be made nor excluded with certainty. A high clinical suspicion and vigilance is required for early diagnosis of TBM. The present case report demonstrates a patient with TB meningitis, who presented with clinical manifestation of isolated left III nerve palsy. Case: A 32 years female was hospitalized with acute onset of left sided ptosis, diplopia and mild generalized headache. Neurological examination at admission revealed isolated left III nerve palsy. CT scan and MRI of Brain showed no specific finding. Lumbar puncture was performed four days later due severe headache, low grade fever and neck rigidity. Cerebrospinal fluid (CSF) study, raised ESR and positive Montoux Test confirmed the diagnosis of TB meningitis. Since TB meningitis is a chronic disease, cranial nerve palsies are common manifestations. This case report suggests that TB meningitis should be considered as a disease of differential diagnosis for isolated III nerve palsy.

Keywords :  III nerve palsy, Tuberculous meningitis, Oculomotor nerve palsy

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