Vision impairment as the first symptom of encephalomyelitis in a paediatric patient

An 8-year-old boy was admitted to the Ophthalmology Department due to a vision impairment with an accompanying decrease in visual acuity and bilateral optic disc oedema. As a result of interdisciplinary diagnostics, acute disseminated encephalomyelitis, probably related to preceding infection, was diagnosed.

OPTIC DISC EDEMA: AN INSIGHT TO THE INSIDE

The presentation of optic disc oedema could be secondary to an extensive set of underlying disorders, from infective to vascular to malignant.[1] Here we present 4 cases, each with a different underlying etiology, presenting to the emergency room (ER), whose careful history and complete evaluation led to finding a systemic cause which would have otherwise been missed and how they need to be be undergoing extensive history and examination to look for underlying etiologies. The series of cases presented here are meant to make the ophthalmology and the medicine residents more aware of the importance of a complete history and extensively examining a patient presenting to the ER with sudden loss of vision.

Resolution of papilledema associated with cyclosporine use after change to tacrolimus

Use of medications including vitamin A derivatives and tetracyclines have been associated with papilledema and raised intracranial pressure. A 46-year-old woman was referred to neuro-ophthalmology for bilateral optic disc oedema and had a 7-year history of cyclosporine use after renal transplantation. She had preserved visual function and moderate bilateral optic disc oedema. Magnetic resonance imaging and magnetic resonance venography of the brain were normal apart from signs of raised intracranial pressure. Lumbar puncture revealed an elevated opening pressure of 40 cm of water with normal cerebrospinal fluid contents. Nephrology was consulted and cyclosporine was switched to tacrolimus and she was treated with acetazolamide. The papilledema resolved within 1 month of her initial visit. It is important to recognise the role that cyclosporine plays in raising intracranial pressure, especially in patients requiring immunosuppression, such as transplant patients. Tacrolimus is a suitable alternative in these cases.