PDF(Pubmed)
Abstract：
Tuberculosis (TB) is a global health concern and central nervous system (CNS) TB leads to high mortality and morbidity. CNS TB can manifest as tubercular meningitis, tuberculoma, myelitis, and arachnoiditis. Neuro-ophthalmological involvement by TB can lead to permanent blindness, ocular nerve palsies and gaze restriction. Visual impairment is a dreaded complication of tubercular meningitis (TBM), which can result from visual pathway involvement at different levels with varying pathogenesis. Efferent pathway involvement includes cranial nerve palsies and disorders of gaze. The purpose of this review is to outline the various neuro-ophthalmological manifestations of TB along with a description of their unique pathogenesis and management. Optochiasmatic arachnoiditis and tuberculomas are the most common causes of vision loss followed by chronic papilloedema. Abducens nerve palsy is the most commonly seen ocular nerve palsy in TBM. Gaze palsies with deficits in saccades and pursuits can occur due to brainstem tuberculomas. Corticosteroids are the cornerstone in the management of paradoxical reactions, but other immunomodulators such as thalidomide and infliximab are being explored. Toxic optic neuropathy caused by ethambutol necessitates careful monitoring and immediate drug discontinuation. Cerebrospinal fluid diversion through ventriculo-peritoneal shunting may be required in patients with hydrocephalus in stage I and II of TBM to prevent visual impairment. Early diagnosis and prompt management are crucial to prevent permanent disability. Prevention strategies, public health initiatives, regular follow-up and timely intervention are essential in reducing the burden of CNS TB and its neuro-ophthalmological complications.
摘要：
结核病（TB）是全球健康问题，中枢神经系统（CNS）结核病导致高死亡率和发病率。中枢神经系统结核可以表现为结核性脑膜炎，结核瘤,脊髓炎,和蛛网膜炎.结核病涉及神经眼科可导致永久性失明，眼神经麻痹和视线限制。视力障碍是结核性脑膜炎（TBM）的可怕并发症，这可能是由于视觉通路在不同水平的参与和不同的发病机制。传出途径受累包括颅神经麻痹和凝视障碍。这篇综述的目的是概述结核病的各种神经眼科表现，并描述其独特的发病机理和治疗方法。视裂性蛛网膜炎和结核瘤是视力丧失的最常见原因，其次是慢性乳头水肿。外展神经麻痹是TBM中最常见的眼神经麻痹。由于脑干结核瘤，可能会出现扫视和追踪不足的凝视麻痹。皮质类固醇是矛盾反应管理的基石，但沙利度胺和英夫利昔单抗等其他免疫调节剂正在探索中。乙胺丁醇引起的毒性视神经病变需要仔细监测并立即停药。TBMI和II期脑积水患者可能需要通过脑室-腹膜分流进行脑脊液分流，以防止视力障碍。早期诊断和及时管理对于防止永久性残疾至关重要。预防战略,公共卫生倡议，定期随访和及时干预对于减轻CNSTB及其神经眼科并发症的负担至关重要.
