10 KMJ 2011; Vol. 3, No. 1: 10-14 LATERAL RECTUS PALSY: AN IMPORTANT SIGN IN DIAGNOSING TUBERCULOUS MENINGITIS C K C K C K C K ORIGINAL ARTICLE INTRODUCTION INTRODUCTION INTRODUCTION INTRODUCTION INTRODUCTION Tuberculosis (TB) is one of the major global causes of morbidity and mortality and majority of these deaths are in developing countries. 1 More than 2000 million people in the world are infected with tubercle bacilli (1/3 of world’s population). The incidence of TB varies from 9 cases per 100,000 population per year in the United States to 110-165 cases per 100,000 population in the developing countries of Asia and Africa. 2-4 In 2009, the global incidence of TB was estimated as 9.4 million cases worldwide equivalent to 137 cases per 100,000 population. 1 Tuberculous meningitis (TBM) occurs in approxi- mately 7-12% of patients with tuberculous disease. 5 The incidence of TBM is directly related to the prevalence of TB infection in general population, which in turn is de- pendent on the socio-economic and hygienic conditions of the community. It accounts for 20-45% of all types of tuberculosis among children. 6 Although TBM is not un- common in Pakistan, there is no community based study available and the published data regarding TBM in Paki- stan is also very limited. 7 TBM is a critical central nervous system (CNS) in- fection with serious consequences of missed or delayed diagnosis. 8 Prognosis of TBM depends on the stage of the illness (stage 1 to stage 3) at the time of diagnosis, according to British Medical Research Council criteria for severity of TBM. 9 Despite the availability of newer and rapid diagnostic and radiologic tools, TBM is always a diagnostic challenge for clinicians. 5,10,11 Due to the broad, variable and nonspecific clinical spectrum, the early di- agnosis of TBM is very difficult. 10 The wide range of pre- sentations of TBM include low grade fever, malaise, head- ache vomiting and signs of meningism to cranial nerve palsies, seizures and features of hydrocephalus. 10-13 Ad- vanced cases may progresses to severe encephalopa- thy with mental state changes, coma and ultimately death. A high index of clinical suspicion of TBM is usually re- quired especially in cases with absence of meningism like in elderly. 14 Although the diagnosis of TBM solely on the basis of clinical findings is not possible, still certain clinical features like cranial nerve palsies and nuchal ri- gidity increase the likelihood of TBM in high risk groups. Verma et al showed that cranial nerves were involved in LA LA LA LA LATERAL RECTUS P TERAL RECTUS P TERAL RECTUS P TERAL RECTUS P TERAL RECTUS PALSY ALSY ALSY ALSY ALSY: AN IMPORT : AN IMPORT : AN IMPORT : AN IMPORT : AN IMPORTANT SIGN IN ANT SIGN IN ANT SIGN IN ANT SIGN IN ANT SIGN IN DIAGNOSING TUBERCUL DIAGNOSING TUBERCUL DIAGNOSING TUBERCUL DIAGNOSING TUBERCUL DIAGNOSING TUBERCULOUS MENINGITIS OUS MENINGITIS OUS MENINGITIS OUS MENINGITIS OUS MENINGITIS Ayesha Zafar Ayesha Zafar Ayesha Zafar Ayesha Zafar Ayesha Zafar 1 , Muhammad Irfan , Muhammad Irfan , Muhammad Irfan , Muhammad Irfan , Muhammad Irfan 2 ABSTRACT ABSTRACT ABSTRACT ABSTRACT ABSTRACT Objective: Objective: Objective: Objective: Objective: To find out the association of lateral rectus palsy in patients with tuberculous meningitis (TBM). Material and Methods: Material and Methods: Material and Methods: Material and Methods: Material and Methods: This study was conducted at Department of Neurology, Lady Reading Hospital, Peshawar from January 2008 to December 2009 on 43 diagnosed patients of TBM. The diagnosis was made on the basis of history, clinical presentation, laboratory and radiological findings. Patients of tuberculous meningitis with or without intracranial tuberculomas or having any extra cranial tuberculosis were included while cases presenting with similar clinical picture but having non tuberculous CNS pathology were excluded from the study. Results: Results: Results: Results: Results: Out of 43 patients, 27 (62.8%) patients were females and 16 (37.3) were males. The age range was from 7 years to 65 years with mean age of 36 years. Out of 43 patients, 11 (25.58%) patients were assigned stage I, 23 (53.48%) stage II and 9 (20.93%) stage III, according to Medical Research Council classification for tuberculous meningitis. Fourteen out of 43 (32.6%) were found to have unilateral or bilateral lateral rectus palsy. Conclusion: Conclusion: Conclusion: Conclusion: Conclusion: The presence of recent onset lateral rectus palsy is an important sign towards the diagnosis of TBM. However more studies are needed to establish the diagnostic value of lateral rectus palsy in diagnosing TBM. Key words: ey words: ey words: ey words: ey words: Lateral Rectus Palsy, Tuberculous Meningitis (TBM), Meningism, Cerebrospinal Fluid (CSF). This article may be cited as: Zafar A, Irfan M. Lateral rectus palsy: An important sign in diagnosing tuberculous meningitis. KUST Med J 2011; 3(1): 10-14. 1 Assistant Professor, Department of Neurology, PGMI, Lady Reading Hospital, Peshawar – Pakistan 2 Department of Psychiatry, PGMI, Lady Reading Hos- pital, Peshawar – Pakistan Address for Correspondence: Dr Dr Dr Dr Dr. Ayesha Zafar . Ayesha Zafar . Ayesha Zafar . Ayesha Zafar . Ayesha Zafar Assistant Professor, Department of Neurology PGMI, Lady Reading Hospital, Peshawar, Pakistan E mail: neurologistpsh@yahoo.com Date Submitted: December 17, 2010 Date revised: June 06, 2011 Date Accepted: June 12, 2011