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[Acute bilateral amaurosis in sphenoid empyema caused by Streptococcus pneumoniae]
C Y Mardin1, S Wolf, M Böswald
1Universitäts-Augenklinik Erlangen.
Patient:
A 14-year-old boy suffered from an acute bilateral blindness which occurred in 24-h time, accompanied by headache and raised temperature, with inconspicuous optic nerve head and fundus. After diagnosis of empyema with magnet resonance tomography (MRT) the sphenoid sinus was fenestrated and streptococcus pneumoniae isolated. Liquor and serology being inconspicuous, there was no evidence of leucaemic or autoimmune disease, intoxication or intracranial tumor.
Clinical Course:
The condition of the patient improved under systemic antibiotic therapy. The bilateral amaurosis remained and opticus atrophy developed.
Conclusion:
A bilateral amaurosis with descending opticus atrophy as a consequence of a sphenoiditis and spreading inflammation to the meninges and the optic nerve in the area of the chiasm is a rare event. The imaging technique of the MRT offers new opportunities for an early and more pointed diagnosis and therapy.
Insights
A rare case of acute bilateral blindness in a boy was caused by sphenoid sinus infection spreading to the optic nerves. Early diagnosis with MRI and antibiotics improved his condition but vision loss persisted.
Area of Science:
- Ophthalmology
- Neurology
- Infectious Disease
Background:
- Acute bilateral blindness is a rare and serious condition requiring prompt diagnosis.
- Sphenoid sinusitis can lead to severe neurological complications if not treated effectively.
Observation:
- A 14-year-old boy presented with acute bilateral blindness, headache, and fever.
- Magnetic Resonance Tomography (MRT) revealed sphenoid sinus empyema.
- Optic nerve head and fundus were initially inconspicuous.
Findings:
- Streptococcus pneumoniae was isolated from the sphenoid sinus.
- Systemic antibiotic therapy led to clinical improvement, but bilateral amaurosis persisted.
- Optic atrophy developed, indicating irreversible optic nerve damage.
Implications:
- This case highlights the rare but severe consequence of sphenoiditis extending to the optic chiasm.
- Magnetic Resonance Tomography (MRT) is crucial for early and precise diagnosis of such complex cases.
- Prompt diagnosis and intervention are vital, though optic nerve damage may be permanent.