DR. VAIBHAV NAGPAL

Dr.PAROMITA DUTTA, Dr. KAMLESH, DR.MANISHA MISHRA

Abstract

Tuberculosis is one of the most common infectious disease in developing nations like India. Tubercular meningitis can present in various ways. However, bilateral third nerve palsy is a very rare presentation.

A 24 yr/M came with drooping of both upper eyelids. He had B/L 3rd nerve palsy associated with increased somnolence and paucity of speech. MRI brain showed a communicating hydrocephalus with multiple inflammatory granulomas in both the cerebellar and cerebral hemispheres. Exudates with few ring enhancing lesions in basal cistern were seen. Cererbrospinal fluid (CSF) analysis revealed increased lymphocytes(60%) and polymorphs(40%).

The patient was presumptively diagnosed as tubercular meningitis on the basis of MRI and CSF tap findings and was started on anti-tuberculosis treatment (ATT) to which he responded.

We report a rare case of B/L third nerve palsy associated with tubercular meningitis. It has been reported with various other causes but not with tubercular meningitis.