Home Archive Vol.40, No.3, 2014 Paradoxical Growth of Optochiasmatic Tuberculoma during the Treatment of Tuberculous Meningitis

Paradoxical Growth of Optochiasmatic Tuberculoma during the Treatment of Tuberculous Meningitis

Ilir Ahmetgjekaj(1), Serbeze Kabashi-Muqaj(1), Luana Corina Lascu(2), Simona Bondari(2), A. Bondari(2)

(1)Clinic of Radiology, UCCK, Prishtina, Kosova, Faculty of Medicine, Pristine University, Imaging Center Prima, Pristine, Kosova, (2)University of Medicine and Pharmacy of Craiova, Romania

    Abstract: Intracranial brain parenchymal tuberculomas may form paradoxically, days to months after starting antituberculous drug therapy. They may develop in and around optic chiasm and optic nerves after antituberculous treatment as a quite rare occurrence in tuberculous meningitis (TBM) this may lead to severe visual loss if not treated properly. We describe a 5 year-old child with documented TBM being treated with first line antituberculous drugs which developed visual impairment 3 months after starting the treatment. MRI after gadolinium administration revealed multiple perichiasmatic ring enhancing lesions due to tuberculomas. Visual impairment developing in a patient on treatment with antituberculous drugs should give rise to a suspicion of rare optochiasmatic tuberculomas; this necessitates urgent contrast-enhanced MRI of the brain and prompt treatment with steroids.
    Keywords: optochiasmatic tuberculoma, paradoxical response, MRI

DOI 10.12865/CHSJ.40.03.14


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Volume 40 Issue 3 2014