Year : 1981 | Volume
: 29 | Issue : 3 | Page : 301--302
Ocular menifestations of tubercular meningitis and their prognostic value in children
BMD Verma1, SK Srivastava1, JR Srivastava2,
1 Department of Ophthalmology, G.S.V.M. Medical College, Kanpur, India
2 Department of Paediatrics, G.S.V.M. Medical College, Kanpur, India
Department of Ophthalmology, G.S.V.M. Medical College, Kanpur
|How to cite this article:|
Verma B, Srivastava S K, Srivastava J R. Ocular menifestations of tubercular meningitis and their prognostic value in children.Indian J Ophthalmol 1981;29:301-302
|How to cite this URL:|
Verma B, Srivastava S K, Srivastava J R. Ocular menifestations of tubercular meningitis and their prognostic value in children. Indian J Ophthalmol [serial online] 1981 [cited 2021 Jul 31 ];29:301-302
Available from: https://www.ijo.in/text.asp?1981/29/3/301/30906
The drastic advance in chemotherapy of tuberculosis has revolutionised the outcome in tubercular meningitis, but its prevalence in India is still continuing to be a challange while in Western countries it has fallen considerably.
MATERIALS AND METHODS
The present study was conducted on 50 proved cases of tubercular meningitis who attended the department of paediatrics and ophthalmology of G.S.V.M. Medical College and L.L.R. and Associated Hospitals, Kanpur. All the cases were under 14 years of age.
In this study out of 50 cases ocular involvement was seen in 76% of cases. The higher incidence may be due to prolongation of life by better treatment.
Corneal ulcer was seen in 3 cases (6%) which is quite low. It may be due to efficient care of eyes during'unconscious state.
Cranial nerve involvement is common feature and in this series the oculomotor nerve involvement was seen in 12% of cases. The third nerve involvement has been explained by basal meningitis, either a direct infiltration of the nerve or by a fibrous band pressing over it. In this series 2 cases (4%) showed a complete third nerve involvement, while 4 patients (8%) showed partial third nerve involvement. Complete involvement showed a mortality rate of 16.6% while there was no mortality in partial nerve involvement, hence shows a better prognosis.
There was no cases of trochlear nerve involvement.
Abducent nerve involvement was in 12% (6 patients). 10% cases had unilateral involvement while 2% cases showed bilateral involvement.
The mortality was 33.3% in this series. Thus it is seen that patients with 6th nerve involvement have a grave prognosis as it reflects on the raised intracranial pressure.
Facial nerve involvement was in 2 patients (4%). This is either due to direct infiltration or due to fibrous band pressing over it in basal meningitis. There was no mortality in this series.
Pupillary involvement was in 40% cases. 8 cases (16%) showed dilated and fixed pupil, 6 cases, (12%) semidilated pupil, 4 cases (8%) sluggish pupil and 2 cases (4%) aniscoria. It is evident that mortality is highest in cases with dilated and fixed pupil i.e. 25%. Pupillary involvement may be due to the nerve involvement or due to pressure on the brain stem by dilation of third ventricle (Richmen's Theory). While Reinhold suggested that in convexial meningitis pupils are usually narrow, but in this study we have not noticed any contracted pupil.
31 cases (62%) had optic nerve involvement, primary optic atropy was in 20% i secondary optic atrophy in 12% cases. There was no mortality in cases with primary optic atrophy showing a good prognosis. It may be due to internal hydrocephalous of third ventricle causing pressure on optic chiasma which inturn causes primary optic atrophy. Igner-Scheiner (1924) suggests it to be descending perineuritis of chiasma and optic nerve.
Temporal pallor was seen in 5 cases (10%). This may be due to ischaemia of optic nerve. There was no mortality thus the prognosis was good.
Secondry optic atrophy was in 12% of cases and all of them remained alive thus showing a good prognosis.
Papilloedema was seen in 8% cases. Out of 4 cases (8%) 3 expired (75%) thus showing a grave prognosis. This low incidence of papilloedema is explained by the presence of inflammatory process obliterating the intravaginal spaces thus preventing its occurance.
6 cases (12%) showed papillitis thus it is more common than papilloedema (8%). Out of 6 cases (12%) two expired (33.3 %) thus showing that mortality rate is lower as compared to cases of papilloedema.
One case out of 50 showed choroid tubercle in one eye ie 2% only. X-ray chest showed a military involvement of the lungs. This case expired within a week inspite of the treatment thus showing a very grave prognosis. One patient had complete primary optic atrophy of both eyes for the last 7 years and showed nystagmoid movements.
Thus it may be concluded that the mortality was highest in cases with abducent nerve involvement while complete third nerve in volvement was the next to show the mortality. Other nerve involvements did not show any mortality. The prognosis in cases with dialated fixed pupils was gravest and next was semi-dilated pupil to cause death. Cases showing papilloedema have a grave prognosis as compared to papillitis which has little less incidence as compared to optic atrophies. There was only one case of choroid tubercle who expired but we can not give a definite opinion regarding prognosis as we did not encounter much cases.