A case of papilledema with TB meningitis with bilateral abducent nerve palsy – A diagnostic challenge

Abstract

Tuberculous meningitis (TBM) contributes around 5% among extrapulmonary tuberculosis (TB) and it is devastating with significant morbidity and mortality. It is associated with high frequency of neurologic sequelae and mortality. TBM has a subacute presentation with non-specific clinical signs making difficulty in early diagnosis. We report a case presenting with only ocular symptoms and no typical signs of meningitis with normal brain imaging. Real time PCR and other nucleic acid amplification methods are increasingly used for detection of mycobacterium TB from cerebrospinal fluid. When recognized early and treated promptly with appropriate anti-tuberculous medication, prognosis is good.