• Manish Kumar Sinha, Ravindra Kumar Garg, H K Anuradha, Atul Agarwal, Anit Parihar, and Palavi Aga Mandhani.
• Department of Neurology Chhatrapati Shahuji Maharaj Medical University, Uttar Pradesh, Lucknow, India.
• J. Infect. 2010 Jun 1;60(6):458-66.

BackgroundParadoxical appearance of new or expansion of existing optochiasmatic tuberculoma, leading to severe vision loss, is a devastating complication in patient with tuberculous meningitis.MethodsWe report a series of 8 cases of tuberculous meningitis that developed paradoxical vision loss associated with optochiasmatic tuberculoma. Clinical assessment and magnetic resonance imaging (MRI) done at presentation, at the time of deterioration, and at 9 months were analyzed.ResultsAll patients had good vision acuity and normal visual field at baseline. None of them had optochiasmatic tuberculoma on magnetic resonance imaging at baseline, though 3 patients had optochiasmatic arachnoiditis. The mean interval of onset of paradoxical optochiasmatic tuberculoma was 41 days after starting antituberculosis therapy. Paradoxical optochiasmatic tuberculoma was associated with vision deterioration in all patients, 6 of whom developed severe vision loss (vision acuity ConclusionPrompt recognition of paradoxical optochiasmatic tuberculoma with the help of vision assessment and neuroimaging is vital for patient's life and vision. Paradoxical reactions should not be labeled as a new or resistant infection. The prior treatment schedule should continue, and dexamethasone may be added or its dose enhanced.Copyright (c) 2010 The British Infection Society. Published by Elsevier Ltd. All rights reserved.

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