Acute unilateral decrease in vision on initial presentation of an adolescent female in the emergency department

Abstract

Background: Optic neuritis is an acute demyelinating inflammation of the optic nerve that leads to acute loss of vision and eye pain worsened with eye movement. It is a relatively rare condition in the pediatric population. Pediatric optic neuritis usually arises following a viral illness. It can present as an initial feature of a systemic demyelinating disease such as multiple sclerosis or neuromyelitis optica, but can also occur as an isolated syndrome. We report a classic presentation of optic neuritis presented to our Emergency Department in Doha, Qatar. Case presentation: A 16-year-old female adolescent, of Asian descent, with no past medical history, presented with acute decrease in vision in her left eye associated with eye pain and mild headache for the past week. There were no other associated symptoms. Vital signs, systemic and neurologic examinations were normal. Pertinent ophthalmologic findings on her left eye examination were as follows: visual acuity: counting fingers at 3 meters aided, color vision 0/15; normal intra-ocular pressure, slight ptosis; sluggish pupil with relative afferent pupillary defect and funduscopy showing hyperemic optic disc with blurring of the nasal margin, normal macula and retinal vessels. Laboratory reports were unremarkable. Head computed tomography (CT) scan showed asymmetric thickening of the left optic nerve with subtle surrounding fat stranding. Brain and spinal cord magnetic resonance imaging (MRI) showed left optic nerve increased signal and thickness in the proximal segment and contrast enhancement in the optic nerve and optic nerve sheet . Lumbar puncture was done. Cerebrospinal fluid (CSF) analysis and culture showed unremarkable results. The patient was admitted with a working diagnosis of optic neuritis for further investigations. Conclusion: The patient fully recovered after receiving steroid treatment for 5 days and was discharged subsequently. Optic neuritis can be seen among young patients, often female, with classic presentation of acute loss of vision and eye pain. It can be the primary manifestation of a chronic demyelinating process.