Internuclear Ophthalmoplegia in Tuberculous Meningitis

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Abstract
Internuclear ophthalmoplegia (INO) is characteristic of lesions of the medial longitudinal fasciculus and usually indicates primary brain stem pathology. Here we describe 2 cases of tuberculous meningitis (TBM) in which INO was a prominent presenting sign. The mechanism of INO in TBM is presumed to be ischemia secondary to involvement of small basilar vessels supplying the MLF in the inflammatory process. In both cases the INO resolved on antituberculous therapy suggesting that the cause of the ischemia is reversible. INO in a patient with meningitis must suggest a basal process probably TBM.

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