Batna Journal of Medical Sciences
Volume 13, Numéro 7, Pages 513-516
2026-07-10

Tuberculous Meningitis Complicated By Acute Hydrocephalus And Bilateral Optic Nerve Atrophy: A Case Report



Authors : Choubane Nabila .

Abstract

Tuberculous meningitis (TBM) is the most severe form of extrapulmonary tuberculosis and is associated with high mortality and long-term neurological sequelae. Early diagnosis remains challenging because of nonspecific clinical manifestations, particularly in endemic areas where delays in treatment significantly worsen outcomes. We report the case of a 24-year-old female physician with no prior medical history who presented with acute agitation and fever. Initial neurological examination was unremarkable, with no focal deficits or meningeal signs. Cerebrospinal fluid analysis revealed lymphocytic pleocytosis (56 cells/mm³, 90% lymphocytes), hypoglycorrhachia, and elevated protein levels, while the initial brain computed tomography scan was normal. Empirical treatment with cefotaxime and acyclovir was initiated for presumed meningoencephalitis. On the third day of hospitalization, the patient experienced rapid neurological deterioration with decreased consciousness and generalized tonic–clonic seizures, requiring intubation and mechanical ventilation. A repeat CT scan demonstrated acute hydrocephalus, leading to emergency external ventricular drainage. Despite a high clinical suspicion of TBM, antituberculous therapy was initially delayed because of the absence of microbiological confirmation and extrapulmonary evidence. Following extubation, the patient developed severe visual impairment, and ophthalmological evaluation revealed bilateral optic neuropathy. Antituberculous treatment was subsequently initiated, and a ventriculoperitoneal shunt was placed. Progressive neurological improvement followed, allowing discharge from the intensive care unit after a two-month hospitalization. At follow-up, visual acuity remained markedly impaired and required corrective lenses. This case highlights the diagnostic challenges of TBM when initial clinical and radiological findings are nonspecific and emphasizes the importance of early empirical antituberculous therapy in high-burden settings, even in the absence of microbiological confirmation, to reduce the risk of irreversible neurological and visual sequelae.

Keywords

Hydrocephalus ; Optic neuropathy ; Neurocritical care ; Central nervous system tuberculosis ; Case report ; Empirical therapy. ; Tuberculous meningitis

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