Encephalitis after viral optic neuritis..case report

Encephalitis followed by optic neuritis:
A case report

CASE PRESENTATION

In kirkuk , iraq 2011 7th of October , 

A 61-year-old female, uncontrolled DM, BP, presented with complaints of severe headache of two-week duration followed by loss of conciouseness for the last 5 hours  with low grade fever and neck stiffness , with purulant  discharge from the right ear and right eye was frozen not moving and there was purulant discharge from it down to the cheek,

. The headache was in the right parietal region accompanied by nausea and vomiting. There was neither any history of fever, photophobia, blurring of vision or diplopia, nor any significant past medical history., we started anti viral bollus dose and anti bacterial doses she start regain conciouseness , after the first bollus dose , another doctor came and stop tbe anti viral assuming it's not viral encephalitis , after 12 hours stopping the anti viral the patient developed repeated fits ended with death.

Sad story but it can give us some red lights .

Just to remind:

Optic neuritis 

is defined as the inflammation of the optic nerve, which causes sudden painful vision loss or reduced vision in the affected eye.Although most cases of optic neuritis are either idiopathic or 

 Encephalitis 

has been included in the causes of optic neuritis, but post encephalitic optic neuritis has been rarely reported. Majority of the cases of optic neuritis are either idiopathic or associated with multiple sclerosis, especially in western countries. This is very important in the Asian population where the incidence and prevalence of multiple sclerosis is not as high as in the Western countries. Although post infectious optic neuritis is more common in children, it can also be found in adults and is usually seen one to three weeks after a symptomatic infective prodrome. Here, we present a case of a 48 year- old-male who developed optic neuritis following viral encephalitis. His first presentation was with severe headache of two weeks duration. Viral encephalitis was diagnosed and treated. The patient presented again three weeks later with right eye pain and other features typical of optic neuritis. Corticosteroid therapy facilitated prompt recovery. Optic neuritis is an uncommon manifestation of encephalitis. It is important that both doctors and patients remain aware of post infectious cause of optic neuritis, which would enable a timely diagnosis and treatment of this reversible cause of vision loss.

 

Dr saif alaa