Pott’s Spine with Tubercular Meningitis and Primary Optic Atrophy: An Enigma with a Rare Cautionary Tale

Abstract

Tuberculosis of spine, known as Pott’s spine, is a significant health risk. Misdiagnosis or delayed diagnosis with lack of timely interventions lead to serious neurological complications and is associated with morbidity and mortality. We present a case of Pott’s spine who developed tubercular meningitis with decreased vision due to primary optic atrophy, to highlight the significance of thorough clinical and neuroradiological workup with instillation of prompt antitubercular therapy in patients of central nervous system tuberculosis (CNS TB). This association of Pott’s spine with decreased vision secondary to primary optic atrophy due to tubercular involvement of the second cranial nerve is very rare. Here, associated risk factors, varied clinical presentations, complications, and treatment of CNS TB are reviewed.

Keywords

Pott’s spine - tubercular meningitis - primary optic atrophy

• References

• 1 Gautam VKS, Khurana S, Singh R. Diagnostic and therapeutic challenges in the surgical management of CNS Tuberculosis. Int J Med Health Sci 2013; 2: 161-169
• 2 Park P, Lewandrowski K, McLain R. Pott’s disease associated with tuberculous meningitis causing blindness. Int J Spine Surg 2006; 3 (02) 00
• 3 Nussbaum ES, Rockswold GL, Bergman TA, Erickson DL, Seljeskog EL. Spinal tuberculosis: a diagnostic and management challenge. J Neurosurg 1995; 83 (02) 243-247
• 4 Leonard JM, Des Prez RM. Tuberculous meningitis. Infect Dis Clin North Am 1990; 4 (04) 769-787
• 5 Gill B, Heavner JE. Postoperative visual loss associated with spine surgery. Eur Spine J 2006; 15 (04) 479-484
• 6 Citron KM, Thomas GO. Ocular toxicity from ethambutol. Thorax 1986; 41 (10) 737-739
• 7 Schild HS, Fox BC. Rapid-onset reversible ocular toxicity from ethambutol therapy. Am J Med 1991; 90 (03) 404-406
• 8 Melamud A, Kosmorsky GS, Lee MS. Ocular ethambutol toxicity. Mayo Clin Proc 2003; 78 (11) 1409-1411
• 9 Trusiewicz D. Farnsworth 100-hue test in diagnosis of ethambutol-induced damage to optic nerve. Ophthalmologica 1975; 171 (06) 425-431
• 10 Gupta M, Bajaj BK, Khwaja G. Paradoxical response in patients with CNS tuberculosis. J Assoc Physicians India 2003; 51: 257-260
• 11 Monga PK, Dhaliwal U. Paradoxical reaction in tubercular meningitis resulting in involvement of optic radiation. Indian J Ophthalmol 2009; 57 (02) 139-141