Response to high dose corticosteroids in a girl with bilateral optic neuritis
Summary. Introduction. Optic neuritis is rare in childhood. Frequently (35-52% of all cases depending on the series) they have, during their clinical course, foci of demyelination leading to the clinical picture of multiple sclerosis (MS). Since 1993, the optic neuritis study group has recommended treatment with high doses of corticosteroids, since this seemed to stop progression, improve long-term results and delay the appearance of MS. The course of our patient was better than we expected. Clinical case. A 10 year old prepubertal girl complained of progressive loss of vision and slight pain in the right eye for 26 days before admission to hospital. On examination there was obvious papillitis of the right ocular fundus with total loss of the pupillary light reflex, together with consensual hyporeflexia of the left eye. Study of the visual evoked potentials (VEP) showed that there was marked delay of the P-100 wave, and a lower amplitude in the right eye. Magnetic resonance imaging did not show any demyelinated focus. Serological testing for neurotropic viruses was negative. Conclusions. After the initial phase of intravenous treatment (third day) there was subjective recovery of vision and the pupillary light reflex returned. VEP studies showed marked recovery. Thirty days after treatment was started there was almost complete subjective and VEP recovery. This rapid progress, as compared to that of other paediatric cases published, suggests a mechanism involving decompression of the optic nerve
Caso clínico Niña prepúber de 10 años, que 26 días antes del ingreso comienza con pérdida progresiva de la visión y dolor leve en el ojo derecho. En la exploración sólo se apreciaba una papilitis evidente en el fondo del ojo derecho con arreflexia pupilar completa a la luz, junto a hiporreflexia consensuada en el ojo izquierdo. El examen de potenciales evocados visuales (PEV) detectó un marcado retraso de la onda P100, con menor amplitud para el ojo derecho. La imagen de resonancia magnética no demostró ningún foco desmielinizante. La serología a virus neurotropos fue negativa.
Conclusiones Tras la fase inicial de tratamiento intravenoso (tercer día) hubo una recuperación subjetiva de la visión y desapareció la arreflexia pupilar a la luz. El estudio de PEV evidenció una clara recuperación. A los 30 días de iniciar el tratamiento, la recuperación subjetiva y de los PEV fue prácticamente completa. Esta rápida evolución, con relación a otros casos pediátricos publicados previamente, sugiere un mecanismo descompresivo del nervio óptico
