Tuberculous pachymenigitis masquerading as orbital pseudotumor.

A 35-year-old woman presented with progressive left side proptosis, ophthalmoplegia and trigeminal neuralgia for one month. Brain MRI showed thickening of tentorium dura mater as typical pachymeningitis but extending to retroand intra-orbital space (figure). CSF study revealed lymphocyte predominant pleocytosis and positive PCR of mycobacterium tuberculosis. We used four combined anti-tuberculous therapy and prednisolone. Follow-up brain MRI showed much improvement of the pachymeningitis after two months.