Cranial Nerve Palsies in Adult Tuberculous Meningitis

J Korean Neurol Assoc > Volume 7(1); 1989 > Article

Journal of the Korean Neurological Association 1989;7(1): 237-242.

성인 결핵성 뇌막염에서의 뇌신경마비

송홍기, 김주한,정경천,김명호

한양대학교 신경과.

Cranial Nerve Palsies in Adult Tuberculous Meningitis

Hong-Ki Song,M.D., Ju-Han Kim,M.D., Kyung-Cheon Chung,M.D., Myung-Ho Kim,M.D.

Department of neurology , College of medicine, Hanyang University

Abstract

It is well known that involvement of the cranial nerves is a relatively common manifestation of tuberculous meningitis because tuberculous exudate is most likely to be located at the base of brain and in the basal cisterns. We reviewed 73 adult patients under the diagnosis of tuberculous meningitis at Hanyang University Hospital during last three and a half years from March, 1986. Patients were classified into two groups according to the presence or absence of cranial nerve palsies. Cranial nerve palsies were noted in 22 patients (30.1%) at the time of admission or in the early period of antituberculous therapy. The oculomotor and abdcens nerves were most commonly involved, followed by the optic nerve. In 10 cases with oculomotor nerve palsy, 7 cases were noted to have involvement of both pupils and extraocular movements, 2 had involvement of one pupil only and one remaining case involved extraocular movements only (spared pupil). Cranial nerve palsies developed 7 to 89 days (median, 21.5) after initial symptoms, and in 10 cases their palsies disappeared within 15 to 65 days (median, 40.9). The incidence of SIADH and basal meningeal involvement were much higher in the cranial nerve palsy group. Increase of total protein and decrease of sugar in initial CSF examination were significant (p<0.05) in the cranial nerve palsy group.