12 year old with bilateral 12 year old with bilateral vision lossvision loss

Raed Behbehani , MDRaed Behbehani , MD

12 year old12 year old

A 12 year old with history of sudden, A 12 year old with history of sudden, sequential, bilateral vision loss x 4 days.sequential, bilateral vision loss x 4 days.

First right eye and 1 day later the left eye.First right eye and 1 day later the left eye.

No photophobia, or redness.No photophobia, or redness.

No fever, headache or neck pain.No fever, headache or neck pain.

Otherwise healthy. Otherwise healthy.

No allergies. No allergies.

Was admitted to Amiri Hospital . Was admitted to Amiri Hospital .

CT and MRI brain was normal.CT and MRI brain was normal.

Received IV steroids x 2 days with mild Received IV steroids x 2 days with mild improvement in vision.improvement in vision.

CBC , ESR CBC , ESR Normal. Normal.

Ophthalmology consult.Ophthalmology consult.

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

or falre.or falre.

Visual field (Confrontation Visual field (Confrontation

Inferior altituidinal defects OU + plus dense Inferior altituidinal defects OU + plus dense central scotomas.central scotomas.

FundusFundus

Questions Questions

What additional information in history you What additional information in history you would like to know ?would like to know ?

Differential Diagnosis ?Differential Diagnosis ?

Investigations ?Investigations ?

Treatment ?Treatment ?

FormulationFormulation

Post-vaccinial optic neuritis.Post-vaccinial optic neuritis.

LHON , infiltrative optic neuropathy, LHON , infiltrative optic neuropathy, inflammatory (sarcoid), dmyelinatinginflammatory (sarcoid), dmyelinating

If no improvement with steroids If no improvement with steroids LHON LHON mutation , LP.mutation , LP.

Trial of steroids (no evidence of efficacy).Trial of steroids (no evidence of efficacy).