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Ophthalmology
Pontine tuberculoma presenting as a true-localising abducens palsy
  1. Sripathi Kamath B1,
  2. Madhurima A Nayak1,
  3. Geover Joslen Lobo2 and
  4. Mahesh Mijar3
  1. 1 Ophthalmology, Father Muller Medical College, Mangalore, Karnataka, India
  2. 2 Neurosurgery, Father Muller Medical College, Mangalore, Karnataka, India
  3. 3 Radiology, Father Muller Medical College, Mangalore, Karnataka, India
  1. Correspondence to Dr Madhurima A Nayak; 14maddy{at}gmail.com

Abstract

An immunocompetent woman in her early 30s presented with a 3-day history of nausea, vomiting and horizontal diplopia. Examination revealed left-sided abducens paresis, with normal visual acuity, pupillary reactions and fundus. There was no papilloedema, neck rigidity or positive neurological signs. Magnetic resonance imaging (MRI) showed a central pontine T2 hypointense ring-enhancing lesion causing compression of the fourth ventricle. Magnetic resonance spectroscopy showed a lipid lactate peak leading to a diagnosis of pontine tuberculoma. The diagnosis was supported by a positive Mantoux and interferon-gamma release assay. There was no other systemic focus of tuberculosis. She was then started on antitubercular therapy (ATT) for 18 months. After 8 months of ATT, a repeat MRI showed a decrease in the volume of the tuberculoma. This case exemplifies a unique case of isolated abducens palsy in the absence of features of raised intracranial tension, which could localise the lesion to the pons.

  • Tuberculosis
  • Brain stem / cerebellum

https://doi.org/10.1136/bcr-2024-263879

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    Footnotes

    • Contributors SK is the guarantor. The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms and critical revision for important intellectual content: SK, MAAN, GJL and MM. The following authors gave final approval of the manuscript: SK. For grammar correction chatGPT was used through you.com.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.