Mycobacterium tuberculosis and Mycobacterium avium-intracellulare complex can infect the brain and eye. The neuro-ophthalmic manifestations of tuberculous meningitis include photophobia, CN III and VI paresis, papilledema, retrobulbar optic neuritis, and anisocoria. Cerebral infarction can result from obliterative endarteritis. Neuroimaging studies may show hydrocephalus, abscess formation, granulomas, and enhancement of the basal meninges with contrast administration. Ethambutol is used along with other medications to treat mycobacterial infection; toxicity from this medication can cause bilateral, progressive, painless vision loss (see Chapter 4).
Figure 14-20 Coronal FLAIR MRI scan shows signal abnormalities mainly affecting the temporal lobes (much greater on the right than the left) in a patient with herpes encephalitis.
(Courtesy of Bronwyn Hamilton, MD.)
Excerpted from BCSC 2020-2021 series: Section 5 - Neuro-Ophthalmology. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.