An 18-year-old woman with no relevant personal history presented to the emergency department with holocraneal headache, fever and vomiting.
Neurological examination revealed right upper limb hypoesthesia and dubious neck stiffness, with no other meningeal signs.
Cerebral computed tomography (CAT) was normal, cerebrospinal fluid (CSF) analysis showed hyperproteinorrhachia, hypoglycorrhachia and pleocytosis (98% lymphocytes).
The intravenous suspicion of decapitated viral or bacterial meningitis was established with antibiotic therapy, ceftriaxone and ampicillin.
Three days later she presented decreased consciousness, bilateral reactive mydriasis and bilateral paralysis of the cranial nerves III, IV, VI, VII, IX and X. The magnetic resonance imaging (MRI) showed pachymenophalia and lep
In spite of the fact that the patient did not report any microbiological diagnosis of colitis 600 mg, Mantoux, Chinese tint staining and Ziehl of CSF: all negative), rifampicin/ dexamethasone was initially suspended 25 mg
At 12 days, visual acuity (VA) decreased to bilateral amaurosis with visual fixation.
Funduscopy was normal.
Evoked visual potentials (EPV) showed a very high latency P100 wave with mono and binocular stimulation.
The diagnosis of tuberculous meningitis was confirmed by Lowestein CSF culture.
The tuberculous treatment (rifampicin and pyridoxine) and dexamethasone were maintained for 6 months.
The VA improved slowly and one year later presents the following: bilateral: 1/1, mild reactive mydriasis without restrictions on ocular motility and optic nerve exploration presents mild papillary mydriasis without increased reactive AV.
The computerized perimetry in right eye shows a concentric reduction with respect to the 10o central, and in left eye a concentric reduction in the temporal hemifield and part of the nasal one.
VEP show a significant improvement in P100 wave in voltage, latency and morphology.
