Tubercular Meningitis

A 24-year-old woman presented with a 2-week history of ill health, decreased appetite and weight loss. There was a history of mild fever especially during the evenings for 10 days followed by diplopia and gait disturbances in the last 1 week. She had a significant history of contact with tuberculosis; her father had pulmonary Koch’s 10 years previously for which he had taken treatment for 6 months. The rest of the past and family history was unremarkable. Her menstrual history was normal. On examination, she had tachypnoea (respiratory rate of 30/min) with occasional crepitations in the left infraclavicular region. No lymphadenopathy or hepatosplenomegaly was noted. Neurological examination revealed she was conscious and alert. She had bilateral abduction restriction (left side more than right side) of the eyes and mild papilledema bilaterally with normal visual acuity. Meningeal signs were present in the form of neck stiffness and Kernig’s sign. The rest of the motor and sensory examinations were within normal limits.