Interactive case (unknown)

1. 12 year old with bilateral
vision loss
Raed Behbehani , MD

2. 12 year old
 A 12 year old with history of sudden,
sequential, bilateral vision loss x 4 days.
 First right eye and 1 day later the left eye.
 No photophobia, or redness.
 No fever, headache or neck pain.
 Otherwise healthy.
 No allergies.

3.  Was admitted to Amiri Hospital .
 CT and MRI brain was normal.
 Received IV steroids x 2 days with mild
improvement in vision.
 CBC , ESR  Normal.
 Ophthalmology consult.

4.  VA : HM , CF 2 meters.
 Color vision : 0/13 OU.
 Pupils : sluggish OU , Right RAPD
 Motility : Full, orthophoric.
 Orbits : Normal RTR.
 TA : 12 mm/Hg OU.
 SLE : Normal anterior segment , no cells
or falre.

5.  Visual field (Confrontation
Inferior altituidinal defects OU + plus dense
central scotomas.

6. Fundus

7. Questions
 What additional information in history you
would like to know ?
 Differential Diagnosis ?
 Investigations ?
 Treatment ?

8. Formulation
 Post-vaccinial optic neuritis.
 LHON , infiltrative optic neuropathy,
inflammatory (sarcoid), dmyelinating
 If no improvement with steroids  LHON
mutation , LP.
 Trial of steroids (no evidence of efficacy).