Cortical blindness (Anton-Babinski Syndrome), an Unusual Manifestation of Central Nervous System Tuberculosis

Anton syndrome, or cortical blindness, consists of an objective blindness in the presence of an intact anterior visual pathway, with the patient expressing a denial of blindness; it is a peculiar form of visual anosognosia. Those patients with this syndrome often show an inappropriate affect and confabulate to conceal their visual loss. The common pathologic process in Anton syndrome is an ischemic event of the occipital circulation, and the most frequent causes are cerebral infarctions in aged patients with vascular risk factors, while hypertensive encephalopathy, eclampsia, hypoperfusion, trauma, tumors, and bacterial meningitis are common in children. Herein we report two patients with Anton-Babinski syndrome related to tuberculous meningitis, cared for at a single center. A search in the literature did not render any similar cases previously reported. The patients had no previous history of vascular risk factors, and the presentation of tuberculous meningitis was atypical: in the context of a rapidly evolving headache, one of the patients had visual changes and mental confusion; the other patient presented with stupor caused by acute hydrocephalus. Ischemic events were documented by imaging studies, and cerebrospinal fluid was inflammatory with positive polymerase chain reaction (PCR) for Mycobacteriumtuberculosis and high adenosine deaminase levels. Antituberculous drugs wereadministered and both patients stabilized; one patient showed no significant visual recovery, while the other was able to walk unassisted but had severe and incapacitating neuropsychiatric sequels at 3 years of follow-up.