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Dynamic Visual Tests to Identify and Quantify Visual Damage and Repair Following Demyelination in Optic Neuritis Patients
Published on: April 14, 2014
Presumed infective meningoencephalitis complicated by bilateral optic neuritis
D M Gore1, G D Hildebrand, R Sekhri
1Department of Ophthalmology, Great Ormond Street Hospital, London, UK. danielmgore@gmail.com
Insights
A severe case of presumed infective meningoencephalitis in a child led to bilateral optic neuritis. Prompt corticosteroid treatment improved vision and neurological deficits.
Area of Science:
- Neurology
- Ophthalmology
- Infectious Diseases
Background:
- Meningoencephalitis can present with diverse neurological complications.
- Optic neuritis is a significant cause of visual impairment.
Observation:
- A 7-year-old girl with presumed infective meningoencephalitis developed altered consciousness, hemiplegia, and severe bilateral optic neuritis.
- Standard antimicrobial and antiviral therapies were ineffective.
Findings:
- High-dose systemic corticosteroids were initiated due to the patient's deterioration.
- The patient showed recovery of optic nerve function and resolution of hemiplegia after corticosteroid administration.
Implications:
- This case highlights the potential for severe optic neuritis in meningoencephalitis.
- Early and aggressive corticosteroid therapy may be crucial for preserving vision in such cases.
Purpose:
To report a case of presumed infective meningoencephalitis complicated by bilateral optic neuritis.
Methods:
Interventional case report.
Results:
A 7-year-old Pakistani girl presented with fever and multiple right-sided focal seizures. Despite empirical treatment with antibiotic, anti-viral and anti-tuberculous therapy for presumed infective meningoencephalitis, she further deteriorated, developing altered consciousness, hemiplegia and severe, bilateral optic neuritis. No infectious agent could be identified. Following the addition of high dose systemic corticosteroid therapy, her optic nerve function in both eyes began to recover. At 3-month follow-up, the hemiplegia had completely resolved, and visual acuity was 6/6 bilaterally with normal pupillary responses.
Conclusions:
This case demonstrates that meningoencephalitis of presumed infective origin may be complicated by acute, severe, bilateral optic neuritis, the latter often mediating profound visual loss. In the setting of rapidly deteriorating vision, aggressive corticosteroid treatment, with antimicrobial cover, albeit unproven, remains the mainstay of treatment.
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