A rare cause of bilateral papilloedema and recently installed strabismus in a child

Poster Details

First Author: L.Voinea ROMANIA

Co Author(s):    A. Dascalu   D. Stana   A. Popa Cherecheanu   D. Serban   A. Panca   R. Pascu

Abstract Details

Purpose:

We present the case of a 13 years-old boy who was admitted for blurred vision, diplopia and recently installed esotropia in the right eye.

Setting:

Anamnesis revealed acute laryngitis (one month before) and hospitalization for nausea, vomiting and diarheea (2 weeks before), treated as a viral gastroenteritis. When the ocular symptoms had appeared, the child was sent to our clinic for further investigations. At the admission, BCVA was of 0.9 for the right eye (RE), slightly blurred, and of 1 for the left eye (LE). The slit lamp exam was normal and Goldmann applano-tonometry was of 14 mmHg in both eyes.

Methods:

The examination of ocular movements revealed limited abduction in the RE, with diplopia and pozitive red-glass test for the sixth cranial nerve paresis. Ophthalmoscopy revealed bilateral significant papilloedema (proeminent of +5 D), tortuous and dilated optic veins, flamed shaped peripapillary hemorrhages and intense oedema in the adiacent retina with macular star in the RE. The IRM exam showed no intracranial tumoral mass, but the presence of cephalorachidian liquid in the optic nerves shields, bilateral. The pediatric neurological examination established the diagnosis of bulbar encephalitis, probably of viral ethiology and recommended general therapy with: tetracosactrin (synthetic form of ACTH), acetazolamide, calcium and B-group vitamins, with favourable further evolution.

Results:

The strabismus and diplopia were the first symptoms which remitted without sequelae, followed, in 4 weeks by the normalization of the aspect of the optic discs. Follow-up at 3 and 6 months after the acute episode was within normal limits.

Conclusions:

The poster presents a rare cause o bilateral papilloedema associated with recently installed strabismus and diplopia which was successfully treated in cooperation with pediatric neurological department. Bulbar encephalitis was caused by the same virus as the laryngitis and gastroenteritis the child presented in his recent history. FINANCIAL DISCLOSURE?: No