TB OR NOT TB – THAT IS THE QUESTION!
Ansari, Yousuf H M-Alvarez, Lidia
Ansari, Yousuf H
M-Alvarez, Lidia
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Sandwell and West Birmingham NHS Trust; Queen Elizabeth Hospital
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2022-06
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Abstract
Background and Aims: Chronic lymphocytic meningitis with marked hypoglycorrhachia (low cerebrosp-inal fluid [CSF] glucose level) is often considered synonymous with infectious meningitis. In endemic, high-burden areas of the world, tuberculosis is the first cause. In this report we highlight the diagnostic dilemmas arising in chronic lymphocytic meningeal infiltrative processes.104EUNOS 2022Methods: We review the clinical, radiological and CSF features of a patient who presented with worsening headaches, features of raised intracranial pressure and abnormal CSF, which had been considered pathog-nomonic of tuberculosis due to an extremely low CSF glucose level.Results: A previously healthy young man of South Asian origin presented with an insidious onset of headaches and was found to have papilloedema. Magnetic resonance imaging of his brain and a whole body computed tomography scan were normal. The basic blood work-up was unremarkable. A lumbar puncture found a raised opening pressure of 32 cmCSF, a raised CSF protein level of 1.72 g/L, a low CSF glucose level of 1.0 mmol/L (compared with a plasma level of 5.0 mmol/L) and a CSF white cell count of 126 cells/μL (10% polymorphs and 90% lymphocytes) with a negative cryptococcal antigen test. On the basis of the suggestive CSF he was diagnosed with probable TB meningitis and anti-tubercular treatment was com-menced. Worsening of symptoms with a new optic neuropathy 6 weeks later prompted a neuro- ophthalmology referral.Conclusions: Herein we describe the journey leading to an unexpected diagnosis and, against all odds, a successful treatment outcome for this patient. We discuss the differential diagnosis with this type of CSF and a brief literature review of potential causes behind extreme CSF hypoglycorrachia in the context of lymphocytic meningitisDisclosures: None.P125A CHILD WITH PAPILLOEDEMA – WHEN RESPONSIBILITY KNOCKS ON THE OPHTHALMOLOGIST’S DOORJoana Santos Oliveira1, Margarida Ribeiro1,2, Mário Lima-Fontes1, Renato Santos Silva1,2, Susana Penas1,2, Fernando Falcão-Reis1,2, Olinda Faria1,2.1. Ophthalmology department, Centro Hospitalar Universitário São João, 4200–319 Porto, Portugal. 2. Faculty of Medicine, Universidade do Porto, 4200–319 Porto, Portugal.Background and Aims: Papilloedema refers to optic disc oedema caused by increased intracranial pressure. Consultation requests for suspected papilloedema in children are frequent in Paediatric Ophthalmology. The distinction between papilloedema and pseudopapilloedema is crucial in the approach and prognosis of children, since failure to diagnose papilloedema can be life-threatening.Methods: This case report describes a case of a 2-year-old child with a Chiari malformation and a history of ventriculo-cisternostomy due to hydrocephalus, who was sent to the Paediatric Ophthalmology Department due to bilateral papillary elevation. The study primarily involved retinography, ocular ultra-sound (US), optical coherence tomography (OCT), and later fluorescein angiography. Results: The results of retinography, ocular US and OCT were inconclusive. Fluorescein angiography identified some early capillary dilation and late papillary hyperfluorescence, with some papillary leakage. Therefore, a diagnosis of papilloedema was confirmed. Taking into account the results of the examinations performed, the Neurosurgery team decided to perform a ventriculo-peritoneal shunt with consequent progressive improvement in the clinical findings. Conclusions: Studying papilloedema in clinical practice can be challenging. Paediatric age increases the difficulty in performing and interpreting the tests performed. We want to emphasise the importance of a complete study given the responsibility placed on the decision since it influences the treatment and prognosis of the patient. Disclosures: None.
Citation
Yousuf H Ansari, Lidia M-Alvarez. TB OR NOT TB – THAT IS THE QUESTION! Neuro-Ophthalmology. 2022, Jun (46):1-139. https://doi.org/10.1080/01658107.2022.2064188
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