Presentation
This patient initially presented with exotropia of the left eye and, after two months, presented progressive deterioration of visual acuity until total loss of vision in the left eye. In the following 24 hours, sudden loss of vision in the right eye also developed.
Patient Data
At the level of the optic nerves, the presence of bilateral perineural fluid in the intraorbital segment is reported, with the enhancement of the nerves upon application of paramagnetic contrast medium at this level, without evidence of thickening of the sheath.
Juxtacortical white matter in the right parietal region with an ovoid-shaped lesion, defined behavior, hypointense on T1, hyperintense on T2, and FLAIR, without restriction to diffusion or magnetic susceptibility artifact, without enhancement after applying paramagnetic contrast.
In the posterior fossa, the cerebellum, medulla, pons, and stalk are identified with adequate morphology and signal intensity. Basal cisterns and fourth ventricle without apparent abnormalities.
Adequate signal intensity of the basal nuclei is observed.
The midbrain, cerebral peduncles, aqueduct, and pineal gland are without abnormalities.
Turkish sella and its contents without apparent anomalies. Corpus callosum with adequate development and morphology.
Ventricular system with normal dimensions, without asymmetry.
Case Discussion
Visual evoked potentials
Visual evoked potentials were performed, demonstrating a severe decrease in the amplitude and prolongation of P-100 of both optic nerves, concluding that she had severe bilateral optic neuropathy.
Discussion
Any inflammatory process that affects the optic nerve is called optic neuritis. There are numerous causes, although often it remains idiopathic.
Inflammation results in edema and demyelination of the nerve. When damaged, there is a deficit or loss in vision, alteration in color vision and field defects, an afferent pupillary defect, nerve edema, and atrophy.
Demyelinating diseases are best known for causing optic neuritis, but other causes include autoimmune and inflammatory diseases, intraocular inflammation, and structures surrounding the eye.
Pediatric patients are more commonly affected bilaterally and anterior papillitis is more common. Optic neuritis is rare in children, and generally, they have a better prognosis than adults. However, this pathology is important since it can have great repercussions on the lives of patients, in addition to being associated with several pathologies.
It is important to remember that vision deterioration in children has a great personal impact on their daily lives, so timely diagnosis and treatment are prioritised.
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