A rare case of Cavernous Sinus Syndrome in a patient with tu
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Cavernous sinus syndrome is a rare manifestation of Tuberculous (TB) meningitis. Initial MRI finding may be normal despite clinical manifestation of complex ophthalmoplegia. Early diagnosis and commencement of tuberculous treatment is crucial as it effects the rate of nerve recovery. A case of 33-year-old Malay gentleman, presented with symptoms associated with elevated intracranial pressure and isolated left sixth nerve palsy which then evolved to complex ophthalmoplegia. Initial MRI brain done revealed no abnormality. Elevated CSF (Cerebrospinal Fluid) protein with raised ESR (Erythrocyte Sedimentation Rate) and repeated MRI (Magnetic Resonance Imaging) which showed inflammatory changes over bilateral cavernous sinus and surrounding structure raised high index suspicion of TB meningitis. He was empirically treated with anti TB medication and he responded well. Further review of repeated MRI orbit and patient revealed resolution left sixth nerve palsy and resolution of inflammation over both cavernous sinus.

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