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Bilateral postinfectious optic neuritis and intravenous steroid therapy in children
1Department of Ophthalmology, University of Oklahoma, Dean A. McGee Eye Institute, Oklahoma City 73104.
Insights
This study reports on six patients with acute, simultaneous, bilateral optic neuritis, likely triggered by viral infections. Prompt treatment with corticosteroids led to rapid and significant visual recovery in all affected individuals.
Area of Science:
- Neuroscience
- Ophthalmology
- Immunology
Background:
- Optic neuritis, inflammation of the optic nerve, can cause vision loss.
- Simultaneous bilateral optic neuritis is rare and often associated with demyelinating diseases.
Observation:
- Six patients presented with acute, simultaneous, bilateral optic neuritis.
- Five patients reported recent viral-like upper respiratory or gastrointestinal illness.
- Severe vision reduction and neurological deficits (seizures, cerebellar dysfunction) were common.
Findings:
- Magnetic resonance imaging (MRI) revealed demyelinating lesions in three patients.
- Lumbar puncture abnormalities were noted in three patients.
- All patients showed rapid and near-complete visual recovery after corticosteroid treatment (intravenous methylprednisolone and oral prednisone).
Implications:
- Acute, simultaneous, bilateral optic neuritis may be a distinct clinical presentation of demyelinating disease.
- Early corticosteroid therapy is effective in restoring vision.
- Further research into the specific viral triggers and immunopathogenesis is warranted.
Abstract:
Six patients presented with acute, simultaneous, bilateral optic neuritis. Five of the six patients admitted to a recent history of a brief upper respiratory or gastrointestinal illness, presumably viral in nature. Visual acuity was severely reduced in all patients. Five of the six patients also demonstrated marked neurologic deficits, including seizure activity and cerebellar dysfunction. Three patients demonstrated enhancing intracranial lesions on magnetic resonance imaging (MRI) consistent with demyelinative plaques, whereas lumbar puncture was abnormal in three patients. HLA tissue typing was performed on five of the six patients. All patients were treated with intravenous methylprednisolone, followed by a 2-month tapering course of oral prednisone. Each patient experienced a rapid and nearly complete recovery of vision during treatment.