Incidence and Risk Factors of Ophthalmic Nerve Palsy in Patients with Tuberculous Meningitis: A Retrospective Study and Literature Review

Abstract

Abstract Background Tuberculous meningitis (TBM) is a severe form of tuberculosis with significant neurological complications, including ophthalmic nerve palsy (ONP). This study aims to evaluate the incidence and risk factors associated with ONP in TBM patients and systematically review the global situation of optic nerve damage in TBM. Methods This retrospective study included 250 patients diagnosed with TBM at Shanghai Public Health Clinical Center from January 2013 to December 2022. Data on clinical features, imaging results, and treatment outcomes were collected and analyzed, followed by logistic regression analysis to identify key risk factors. Results A total of 250 patients were enrolled in this study. The incidence of ONP was 6.8% (17/250). Patients with ONP had higher intracranial pressure (ICP) (257.69 ± 68.12 mmH2O vs. 191.65 ± 91.58 mmH2O, P = 0.012), higher cerebrospinal fluid (CSF) protein levels (1702.00 [963.70-3074.75] mg/L vs. 967.45 [513.50-1708.73] mg/L, P = 0.016), and more tuberculomas compared to those without ONP (29.4% vs. 10.7%, P = 0.039). Logistic regression analysis identified pre-treatment ICP, CD4 percentage, and presence of tuberculomas as significant risk factors for ONP. Linezolid use was found to be an independent protective factor for the recovery of ONP, with a odds ratio of 16.360 (95% confidence interval: 1.004–266.666, P = 0.050). Conclusion 6.8% (17/250) of patients with TBM developed ONP as a complication. ICP, CD4 counts, and tuberculomas are important predictors of ONP. Linezolid shows potential as a therapeutic agent for improving outcomes in TBM patients with neurological complications, warranting further study.