Vision impairment in tuberculous meningitis: Predictors and prognosis

Abstract 

Background

Vision impairment is a devastating complication of tuberculous meningitis. In the present study we evaluated the predictors and prognostic significance of vision impairment in tuberculous meningitis.

Methods

In this study, 101 adult patients with tuberculous meningitis were evaluated for vision status and physical disability and were followed up for 6months. Contrast enhanced magnetic resonance imaging (MRI) was performed at baseline and 6months.

Result

Out of 101 patients, 74 patients had normal vision and 27 patients had low vision or blindness at enrollment. Thirteen patients died during the study period. Out of 88 patients who survived at 6months, 68 patients had good vision, 11 patients had low vision and 9 patients had blindness. Predictors of vision deterioration were papilledema, cranial nerve palsies, raised cerebrospinal fluid protein (>1g/L), and presence of optochiasmatic arachnoiditis in MRI. Predictors of blindness, at 6months, were found to be papilledema, vision acuity ≤6/18, cranial nerve palsies, tuberculous meningitis stage II or III, raised cerebrospinal fluid protein (>1g/L), optochiasmatic arachnoiditis, and optochiasmal tuberculoma. At 6months, 27 patients had death or severe disability. Predictors of death or severe disability at 6months were vision acuity ≤6/18, cranial nerve deficits, hemiparesis, clinical stage II or III, and presence of infarct in MRI.

Conclusion

Vision impairment occurred in one-fourth of patients with tuberculous meningitis. Principal causes of vision loss were optochiasmatic arachnoiditis and optochiasmal tuberculoma. Impaired vision predicted death or severe disability.

Keywords: Pulmonary tuberculosis, Tuberculous meningitis, Cerebral tuberculoma, Vision loss, Optic atrophy, Optochiasmatic arachnoiditis