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A young adult presented with headache, bilateral retro-orbital pain, decreased visual acuity (VA) bilaterally and left sided facial paraesthesias. Visual failure occurred over 3 days. There were no other neurological symptoms. Recent history included a viral illness with fever, headache and pharyngitis. There was no past medical history.
On examination, best VA was 6/5 on the right and 6/60 on the left with a relative afferent pupillary defect. Visual field examination revealed severe loss bilaterally: the left eye had superior nasal quadrant perception of hand movement; the right had superior hemifield perception of count fingers (figure 1A,B). Colour perception was absent on the left and reduced on the right. Fundoscopy revealed bilateral papillitis (figure 2A,B). Extraocular movements were normal. Pinprick sensation was decreased in all divisions of the left trigeminal nerve. Otherwise, the neurological examination revealed bilateral hyperreflexia but flexor plantar …
Both authors contributed equally to this article.
Contributors Both authors contributed equally in preparation of the article for submission.
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.