Neuro-ophthalmic features in pediatric tubercular meningoencephalitis

Purpose: To examine the neuro-ophthalmic profile in childhood tubercular me ningoencephalitis and assess its prognostic importance. Methods: One hundred consecutive patients with tubercular meningoencephalit is underwent evaluation for optic nerve functions, supra- and intranuclear oculomotor involvement, and raised intracranial tension. Patients underwent follow-up for 9 months. Results: In 100 patients with tubercular meningoencephalitis, 67 had neuro- ophthalmic features, Common findings were retrobulbar neuritis (32) and gaz e palsy (20). Others, in decreasing prevalence, were third and sixth nerve palsy, conjugate deviation, primary optic atrophy, and complete ophthalmopl egia. Raised intracranial tension was associated with neuro-ophthalmic feat ures in 53 of 67 patients (P < .05). Complete ophthalmoplegia was significa ntly associated with mortality on logistic regression analysis (relative ri sk, 6.35; P=.012). By 6 months, 56% of patients with retrobulbar neuritis p rogressed to optic atrophy. Conclusion: Neuro-ophthalmic features, in association with raised intracran ial tension, often are a part of pediatric tubercular meningoencephalitis p resentation. The type of neuro-ophthalmic features may have prognostic valu e. Optic nerve involvement is the most common finding in tubercular meningo encephalitis.