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CC BY 4.0 · Libyan International Medical University Journal 2023; 08(01): 003-007
DOI: 10.1055/s-0043-1768222
Case Report

Tubercular Optochiasmatic Arachnoiditis: A Case Report with Current Therapeutics and Management

Satish Swain 
1   Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
,
Akansha Didwania
1   Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
,
Abhishek Anand
2   Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
,
Upendra Baitha
1   Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
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Abstract

Central nervous system tuberculosis (CNS TB) involves the brain parenchyma, meninges, and spinal cord. The primary pathology in CNS TB includes thick basal exudates leading to intense meningeal inflammation, vasculitis, and hydrocephalus. When these exudates and inflammation predominantly involve the structure in and around suprasellar cistern region, it results in a condition called optochiasmatic arachnoiditis (OCA). OCA is one of the cataclysmal complications of CNS TB, leading to vision loss. A previously healthy young woman came to our center with the complaints of low-grade fever, headache, weight loss, and visual obscuration. For further evaluation, she underwent lumbar puncture, and based on cerebrospinal fluid analysis, she was a diagnosed with CNS TB and was promptly started on antitubercular therapy along with steroid. A contrast-enhanced magnetic resonance imaging of the brain and orbit showed OCA. For OCA, she was given pulse-dose dexamethasone along with intrathecal hyaluronidase with which there was marginal improvement in vision. Management of OCA can be very challenging with unsatisfactory response. Many agents such as pulse steroid, intrathecal hyaluronidase, thalidomide, tumor necrosis factor alpha inhibitors, and cyclophosphamide have been used with inconsistent results. We have also done a review of the literature for the current evidence and newer therapeutics available for the management of OCA.

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Keywords

optochiasmatic arachnoiditis - CNS tuberculosis - steroid - tuberculosis

Ethics Approval

This study does not require ethics approval as it is a case report. Consent has been taken from the patient directly.


Author Contribution

S.S., A.D.: conceptualization. S.S., A.D., A.A., U.B.: involved in patient management. All authors contributed to the drafting of the initial manuscript. S.S. and U.B. proofread and reviewed the manuscript.




Publication History

Article published online:
20 April 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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