AJNN

The Academic Journal of Neurology and Neurosurgery deals with Neurology and Neurosurgery accepts articles on these topics. Academic Journal of Neurology and Neurosurgery publishes original research articles, review articles, case reports, editorial commentaries, letters to the editor, educational articles, and conference/meeting announcements.

EndNote Style
Index
Case Report
Third cranial nerve palsy as an initial presentation of tuberculous meningitis
In this case report, we present a 54-year-old male patient diagnosed with tuberculous meningitis after presenting with third cranial nerve palsy. Tuberculous meningitis is a rare but potentially fatal infection in certain clinical conditions, and its diagnosis can be challenging, especially when patients present with atypical symptoms. Early treatment is crucial, as delayed therapy may lead to a high risk of mortality. This case report highlights the importance of considering tuberculous meningitis in the differential diagnosis after excluding other common and life-threatening causes in the presence of atypical findings, such as third cranial nerve palsy. Prompt initiation of treatment is essential when there is clinical suspicion.


1. Matsumoto H, Sasaki A, Nakamura Y, et al. Tuberculous meningitis during chemotherapy for advanced gastric cancer. Case Rep Oncol. 2018;11(1):228-233. doi:10.1159/000488313
2. García-Grimshaw M, Gutiérrez-Manjarrez FA, Navarro-Álvarez S, González-Duarte A. Clinical, imaging, and laboratory characteristics of adult Mexican patients with tuberculous meningitis: a retrospective cohort study. J Epidemiol Glob Health. 2019;10(1):59. doi:10.2991/jegh.k. 191023.001
3. Pinzon RT, Veronica V. Hydrocephalus caused by tuberculous meningitis in an immunocompetent young adult: a case report. Int Med Case Rep J. 2023;16:187-192. doi:10.2147/IMCRJ.S389204
4. Donovan J, Figaji A, Imran D, Phu NH, Rohlwink UK, Thwaites G. The neurocritical care of tuberculous meningitis. Lancet Neurol. 2019;18(8): 771-783. doi:10.1016/S1474-4422(19)30154-1
5. Shibeesh AP, Beevi BK, Valliyot B, Sarin S, Kumar KKS. Analysis of cerebrospinal fluid adenosine deaminase level in tuberculous meningitis and validation of sensitivity and specificity. Int J Res Med Sci. 2018;6(2):438. doi:10.18203/2320-6012.ijrms20180007
6. Sünbül M, Atilla A, Esen Ş, Eroğlu C, Leblebicioğlu H. Thwaites’ diagnostic scoring and the prediction of tuberculous meningitis. Med Princ Pract. 2005;14(3):151-154. doi:10.1159/000084631
7. Ashizawa N, Kubo RT, Tagawa R, et al. Efficacy of intrathecal isoniazid and steroid therapy in refractory tuberculous meningitis. Intern Med. 2024;63(4):583-586. doi:10.2169/internalmedicine.1917-23
8. Botha H, Ackerman C, Candy S, et al. Reliability and diagnostic performance of CT imaging criteria in the diagnosis of tuberculous meningitis. PLoS One. 2012;7(6):e38982. doi:10.1371/journal.pone. 0038982
9. Siahaan AMP, Tandean S, Indharty RS, Nainggolan BWM, Susanto M. Paroxysmal sympathetic hyperactivity syndrome in tuberculous meningitis with paradoxical reaction. Int J Surg Case Rep. 2022;99: 107619. doi:10.1016/j.ijscr.2022.107619
10. Tamar M, Levan R, Tinatin G, et al. Reactivation of tuberculosis in COVID-19 infected patient: case report. Med Case Stud. 2023;12(1):1-3. doi:10.5897/MCS2023.0139
11. Seddon JA, Tugume L, Regan S, Prasad K, Bahr NC. The current global situation for tuberculous meningitis: epidemiology, diagnostics, treatment and outcomes. Wellcome Open Research. 2019;4:167. doi:10. 12688/wellcomeopenres.15535.1
12. Thwaites GE, Chau TT, Mai NT, et al. Tuberculous meningitis. J Neurol Neurosurg Psychiatry. 2004;75(4):499-507. doi:10.1136/jnnp.68.3.289
13. Misra UK, Kalita J, Nair PP. Tuberculous meningitis and cranial nerve palsies: a clinical study. J Neurol Sci. 1993;118(1):27-32.
14. Sütlaş PN, Ünal A, Forta H, Taşci B, Erbengi A. A prospective study of 50 adult patients with tuberculous meningitis at Ankara. J Infect. 2003; 47(4):317-320.
15. Kennedy DH, Fallon RJ. Cranial nerve palsies in tuberculous meningitis. Q J Med. 1979;48(192):241-253.
Volume 2, Issue 2, 2025
Page : 35-37
_Footer