Lateral rectus palsy: An important sign in diagnosing tuberculous meningitis

Objective: To find out the association of lateral rectus palsy in patients with tuberculous meningitis. Material and Methods: This case series included 43 patients admitted in Department of Neurology, Lady Reading Hospital, Peshawar from January 2008 to December 2009 and diagnosed to have tuberculous meningitis on the basis of history, clinical presentation, laboratory and radiological findings. Inclusion criteria included direct or indirect evidence of tuberculous meningitis with or without intracranial tuberculomas or any extra cranial tuberculosis while exclusion criteria included the evidence of any another central nervous system pathology other than tuberculosis accounting for the patient’s clinical features. Results: There were 27 female and 16 male patients with a mean age of 36 years. Out of 43 patients, 11 (25.58%) were assigned stage I, 23 (53.48%) stage II and 9 (20.93%) stage III, according to medical Research Council classification for tuberculous meningitis. Fourteen out of 43 were found to have unilateral or bilateral lateral rectus palsy. Conclusion: The presence of recent onset lateral rectus palsy is an important sign towards the diagnosis of tuberculous meningitis. Key words: lateral rectus palsy, Tuberculous meningitis (TB Meningitis), Meningism, Cerebrospinal fluid (CSF).