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January 1971

Tuberculoma of the Left Optic Nerve and Chiasm

Author Affiliations

From the departments of ophthalmology (Dr. Schlernitzauer), radiology (Dr. Hodges), and neurosurgery (Dr. Bagan), the Johns Hopkins Hospital and School of Medicine, Baltimore.

Arch Ophthalmol. 1971;85(1):75-78. doi:10.1001/archopht.1971.00990050077011

TUBERCULOMA of the central nervous system (CNS) is rare in nations with a high standard of living. In other countries such as India, however, the incidence of tuberculoma among intracranial tumors even in recent years has been as high as 20%.1

A high incidence of ophthalmologic abnormalities occurs in patients with intracranial tuberculomas, even though the lesions do not directly involve the central visual pathways. The most common abnormalities are extraocular motor nerve palsies, visual field defects, and impaired visual acuity, all of which are usually secondary to increased intracranial pressure.

A review of the literature indicates that it is rare for tuberculomas to involve directly the central visual pathways. In 1862, Cruveilhier2 described the first case of tuberculoma involving an optic nerve, and five years later Hjort3 reported the first case of chiasmal involvement. Since then, only 11 cases of tuberculoma directly involving either the chiasm

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