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Bilateral optic neuritis following chicken pox
BILATERAL OPTIC NEURITIS FOLLOWING CHICKEN POX REPORT OF CASE WITH .APPARENTLY COMPLETE RECOVERY
HARVEY A.
ttATC~t, M.D.
IDAHO I~ALI,S, IDAHO
E U R O L O G I C A L symptoms a f t e r chicken pox are relatively rare. A great variety of symptoms have been reported, including unconsciousness, deliN rium, tremors, ataxia, cerebellar syndromes, spinal paraplegias, etc. Cranial nerve palsies have occurred, usually combined with other syulptoms. Involvemerit of the optic nerve has been reported by Ford. Bilateral involvement of the optic nerves without other symptoms Inay not have been seen. This case is presented because of its r a r i t y and interest. CASE REPORT
About March 28, 1948, a 5-year-old white male child developed chicken pox: He had a generalized eruption but was not particularly ill. He was restricted to bed for the first week and his convalescence seemed uneventful. Two weeks after the onset, he was heard to complain that it was dark outside and the next day lie complained of darkness in the house. Within the next few days he became unable to find food set in front of him and was unable to find the fork and spoon to eat. The early development and family history are irrelevant. Physical examination showed a well-developed, well-nourished child of 5 years, weight 441/2 pounds, height 4 4 8 9 inches, temperature 99.2 ~ F. (R). Eyes showed bilaterally engorged retinal veins and elevated discs. Vision, especially central vision, was markedly impaired. He was able to distinguish dark and light, but fingers held before the eyes could not be counted. The remainder of physical examination was essentially negative. There were no stiff neckl reflex changes, or other nerves involved. The patient was seen by a local ophthalmologist who confirmed the eye findings and recommended neurological consultation because of the possibility of an intracranial neoplasm. We believed it to be a postvaricella encephalitic picture limited to the optic nerves. Because of the r a r i t y of this condition, the child was sent to the Pediatric D e p a r t m e n t of the University of Utah Medical School, where he was examined by Dr. C. Harrison Snyder of the Department of Pediatrics and Dr. Alan Crandall of Ophthalmology Department. Their findings confirmed the visual changes and an elevated disc of 3 8 9 D. bilaterally with appearance of papillitis. Laboratory studies on April 18, 1948, revealed hemoglobin of 16.2 Gin. per 100 e.e. and red blood cells 6,010,000 per cubic millimeter. The hematocrit was 44 per cent packed cells, with an Wintrobe erythrocyte sedimentation rate of 5 ram. per hour. White blood count was 12,700, polymorphonuclears were 47 per cent, eosinophiles 2 per cent, basophiles 1 per cent, ]ymphocytes 47 per cent, and Inonoeytes 3 per cent. Examination of the spinal fluid showed a pressure of 165 ram. of water, Queekenstedt sign was normal bilaterally, there were no cells, negative pandy, and normal protein. Electroeacephalogram was within normal limits. The vision remained very poor for two weeks and then began to improve very slowly. Within a week after the vision had begun to return, a test of ~rom the Hatch Clinic, Idaho Ft~lls. 758
HATCH:
BILATERAL OPTIC NEURITIS FOLLOWING CHICKEN POX
759
20/50 was obtained in each eye. Six weeks after the beginning of the blindness 20/30 vision was found bilateral]y a n d the nerve heads were practically normal in appearance. T h e r e a f t e r no f u r t h e r i m p r o v e m e n t in vision occurred. The patient felt well subjectively all the time. The vision previous to the illness was not known. SUMMARY T h e c a s e is p r e s e n t e d o f a 5 - y e a r - o l d c h i ] d w i t h b i l a t e r a l o p t i c n e u r i t i s d e v e l o p i n g m a r k e d i m p a i r m e n t of v i s i o n t w o w e e k s a f t e r c h i c k e n p o x . T h e r e was almost complete recovery within two months. REFERENCES Ford, F. R.: Diseases of the Nervous System in Infancy & Childhood~ ed. 1, Springfield, Ill., 1937, Char]es C Thomas. t(rabbe, Js It.: Varicella-Myelitis, Brain 48: 535~ 1925. Underwood, A.: The Neur~)logieal Complications of Varicella; A Clinical and Epidemiology Study, J~rit. J. Child. Dis. 32: 83, 1935. Van Bogaert, L.: Les manifestations nerveuses au eours des maladies eruptives, Rev. neuro]. 1: 150~ 1933. - - " Histopathblogische Studie fiber die Encephalitis naeh Windpacken, Ztsehr. f. d. ges. Neuro]. u. Psyehiat. 140: 201, 1932. Wilson, R. E., and Ford~ F. R.: The Nervous Complications of Yario]a~ Vaeeinia and Varicella. Bull. Johns Hopkins Itosp. 40" 337, 1927. Zimmerman, H. M., and Yannet~ It.: Non-suppurative Encephalomyelitis Accompanying Chicken-Pox, Arch. Neuro]. & Psyehiat. 26: 322, 1931.
HARVEY A.
ttATC~t, M.D.
IDAHO I~ALI,S, IDAHO
E U R O L O G I C A L symptoms a f t e r chicken pox are relatively rare. A great variety of symptoms have been reported, including unconsciousness, deliN rium, tremors, ataxia, cerebellar syndromes, spinal paraplegias, etc. Cranial nerve palsies have occurred, usually combined with other syulptoms. Involvemerit of the optic nerve has been reported by Ford. Bilateral involvement of the optic nerves without other symptoms Inay not have been seen. This case is presented because of its r a r i t y and interest. CASE REPORT
About March 28, 1948, a 5-year-old white male child developed chicken pox: He had a generalized eruption but was not particularly ill. He was restricted to bed for the first week and his convalescence seemed uneventful. Two weeks after the onset, he was heard to complain that it was dark outside and the next day lie complained of darkness in the house. Within the next few days he became unable to find food set in front of him and was unable to find the fork and spoon to eat. The early development and family history are irrelevant. Physical examination showed a well-developed, well-nourished child of 5 years, weight 441/2 pounds, height 4 4 8 9 inches, temperature 99.2 ~ F. (R). Eyes showed bilaterally engorged retinal veins and elevated discs. Vision, especially central vision, was markedly impaired. He was able to distinguish dark and light, but fingers held before the eyes could not be counted. The remainder of physical examination was essentially negative. There were no stiff neckl reflex changes, or other nerves involved. The patient was seen by a local ophthalmologist who confirmed the eye findings and recommended neurological consultation because of the possibility of an intracranial neoplasm. We believed it to be a postvaricella encephalitic picture limited to the optic nerves. Because of the r a r i t y of this condition, the child was sent to the Pediatric D e p a r t m e n t of the University of Utah Medical School, where he was examined by Dr. C. Harrison Snyder of the Department of Pediatrics and Dr. Alan Crandall of Ophthalmology Department. Their findings confirmed the visual changes and an elevated disc of 3 8 9 D. bilaterally with appearance of papillitis. Laboratory studies on April 18, 1948, revealed hemoglobin of 16.2 Gin. per 100 e.e. and red blood cells 6,010,000 per cubic millimeter. The hematocrit was 44 per cent packed cells, with an Wintrobe erythrocyte sedimentation rate of 5 ram. per hour. White blood count was 12,700, polymorphonuclears were 47 per cent, eosinophiles 2 per cent, basophiles 1 per cent, ]ymphocytes 47 per cent, and Inonoeytes 3 per cent. Examination of the spinal fluid showed a pressure of 165 ram. of water, Queekenstedt sign was normal bilaterally, there were no cells, negative pandy, and normal protein. Electroeacephalogram was within normal limits. The vision remained very poor for two weeks and then began to improve very slowly. Within a week after the vision had begun to return, a test of ~rom the Hatch Clinic, Idaho Ft~lls. 758
HATCH:
BILATERAL OPTIC NEURITIS FOLLOWING CHICKEN POX
759
20/50 was obtained in each eye. Six weeks after the beginning of the blindness 20/30 vision was found bilateral]y a n d the nerve heads were practically normal in appearance. T h e r e a f t e r no f u r t h e r i m p r o v e m e n t in vision occurred. The patient felt well subjectively all the time. The vision previous to the illness was not known. SUMMARY T h e c a s e is p r e s e n t e d o f a 5 - y e a r - o l d c h i ] d w i t h b i l a t e r a l o p t i c n e u r i t i s d e v e l o p i n g m a r k e d i m p a i r m e n t of v i s i o n t w o w e e k s a f t e r c h i c k e n p o x . T h e r e was almost complete recovery within two months. REFERENCES Ford, F. R.: Diseases of the Nervous System in Infancy & Childhood~ ed. 1, Springfield, Ill., 1937, Char]es C Thomas. t(rabbe, Js It.: Varicella-Myelitis, Brain 48: 535~ 1925. Underwood, A.: The Neur~)logieal Complications of Varicella; A Clinical and Epidemiology Study, J~rit. J. Child. Dis. 32: 83, 1935. Van Bogaert, L.: Les manifestations nerveuses au eours des maladies eruptives, Rev. neuro]. 1: 150~ 1933. - - " Histopathblogische Studie fiber die Encephalitis naeh Windpacken, Ztsehr. f. d. ges. Neuro]. u. Psyehiat. 140: 201, 1932. Wilson, R. E., and Ford~ F. R.: The Nervous Complications of Yario]a~ Vaeeinia and Varicella. Bull. Johns Hopkins Itosp. 40" 337, 1927. Zimmerman, H. M., and Yannet~ It.: Non-suppurative Encephalomyelitis Accompanying Chicken-Pox, Arch. Neuro]. & Psyehiat. 26: 322, 1931.