Patient's Query
Hello doctor,
Patient is a 61 year-old female. Six months ago she was diagnosed with bone TB and undergoing medication (Ethambutol, Rifampicin, and Isoniazid). After six months of usage, her eye vision is suddenly diminishing. Then her doctor told to discontinue Ethambutol immediately and started using some B12 1500 mg injections on alternate days. After one week they started steroids just to rule out if there might be any optic nerve inflammation. We have done MRI and the findings are below.
1. Tiny FLAIR hyperintense foci in the frontal and parietal and white matter small vessel ischemic changes.
2. Widened perioptic CSF space.
3. T2 hyperintense signal is seen in the chiasm and optic tract.
Kindly suggest what to do?
Hello,
Welcome to icliniq.com.
I passed carefully through your question and reviewed your uploaded MRI (magnetic resonance imaging) report. (attachment removed to protect patient identity).
I would explain that these MRI findings (T2 hyperintensity in the optic nerve and the optic chiasm) are indicative of optic nerve inflammation (neuritis), which could be related to Ethambutol adverse effects. The troubles with vision are a clinical sign of optic neuritis too.
So, considering that there is a correlation between radiological and clinical findings, I would conclude about optic neuritis and would recommend to stop Ethambutol as soon as possible in order to avoid possible blindness.
I hope this helps.
Patient's Query
Thank you doctor,
We have already stopped Ethambutol. Even after stopping Ethambutol (after three weeks), her vision deteriorated further. We are currently using Prednisolone steroids and the TB medication excluding Ethambutol. Is there anything we can do to restore her vision? We are also using B12 injections.
Hello,
Welcome back to icliniq.com.
I agree with your doctor on the decision of starting vitamin B12 and steroid therapy. There is nothing more to do, besides wait and see if her situation improves.
Steroids (Prednisolone) can help reduce the inflammation (neuritis), but it may take up to a month to see good results. So, try to be patient and see how her situation is going to improve because unfortunately there is no other therapy that can help in this situation.
I hope this helps.
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Answered byDr. Aida Abaz Quka
Medically reviewed byDr. Vinodhini J.
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