Tuberculous meningitis (TB meningitis) is a subacute or chronic meningitis with diverse manifestations. Isolated oculomotor nerve palsy and with multiple cerebellar tuberculomas as initial manifestation is rare and uncommon.

We report a rare case of oculomotor nerve palsy associated with multiple cerebellar and cerebral tuberculous granuloma associated with mild meningoencephalitis

 A 25-year-old male was brought to the emergency department in a mild confusional state with short 2 days history of fever. He also gave a history on one episode of convulsion.

Clinical examination revealed isolated left-sided 3rd nerve palsy with complete ptosis diplopia and anisocoria with mild meningism.

Subsequently His reports-GAD-CONTRAST MRI WITH SPECTROSCOPY with MRI-Spectroscopic peaks of lipids strongly indicated tubercular etiology.

spinal fluid was appropriately tubercular in nature

He was immediately started on 4 anti-tuberculous drugs regimes and anti-epileptics

He became normally oriented with resolution of 3rd nerve palsy and seizure free within 3-4 weeks of therapy.

Patients with tuberculosis meningitis presents with abrupt onset oculomotor nerve palsy, rapid diagnosis should be undertaken and proper treatment initiated, as outcome and prognosis is time dependent.

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Dr Milan Chhetri

MD. MRCP. D-Card

Consultant Physician Medicine, Apollo Hospital- Calcutta, India