Sestre Milosrdnice University hospital and Institute of Clinical Medical Research
Abstract
Tuberculous meningitis has a highly variable presentation. Difficulties in establishing the diagnosis of tuberculous meningitis have been well recognized. Unusual manifestations of tuberculous meningitis are nowadays quite frequently seen, with an increasing incidence of the disease in the general neurology practice. A 44-year-old woman presented with progressive loss of vision on the left eye in the past two days and two episodes of seizures (partial and secondary generalized). One week before that, she had transient diplopia, blurred right vision, and gait unsteadiness. There was no past history of systemic tuberculosis. Transcranial Doppler findings first suggested that it was a basal pathologic process with vascular involvement, which was not clear from clinical history and examination, computed tomography or angiography findings. Our opinion is therefore that every case of specific meningitis, infectious retrobulbar neuritis and opticochiasmatic arachnoiditis should be additionally examined with transcranial Doppler. Thus, more reliable information concerning complications due to specific arteritis could be obtained.Tuberkulozni meningitis pokazuje velike razlike u manifestaciji. Dobro su poznate teškoće u postavljanju dijagnoze tuberkuloznog meningitisa. Danas se vrlo često bilježe neuobičajene manifestacije tuberkuloznog meningitisa, uza sve veću incidenciju ove bolesti u općoj neurološkoj praksi. Žena u dobi od 44 godine primljena je s progresivnim gubitkom vida na lijevom oku kroz prethodna dva dana i dvjema epizodama konvulzija (djelomične i sekundarne generalizirane). Tjedan dana prije toga imala je prolazne dvoslike, zamagljen vid i nesiguran hod. Nije imala anamnezu sistemske tuberkuloze. Nalaz transkranijskog Dopplera je bio prvi koji je ukazao na to da se radi o bazalnom patološkom procesu sa zahvaćenim krvnim žilama, što nije bilo jasno iz kliničke anamneze i pregleda, kao ni iz nalaza kompjutorizirane tomografije i angiografije. Stoga je naše mišljenje da pregled transkranijskim Dopplerom treba provesti u svakom slučaju specifičnog meningitisa, infektivnog retrobulbarnog neuritisa i optikohiazmatskog arahnoiditisa. Time bi se dobili pouzdaniji podaci o komplikacijama uzrokovanim specifičnim arteritisom
