[Recurrence of a retrobulbar neuritis? Classic VEP and missing periocular pain].
BACKGROUND
In young patients with the clinical symptoms of a neuritis neuroradiological imaging is not always necessary. This case report describes a young patient who suffered from a recurrence after 5 years. Since all findings, particularly visual evoked potentials, were classic for neuritis, the patient was treated for neuritis although periocular pain was not present.


METHODS
Five years after a neuritis of the left eye (OS), the patient was again referred with a visual loss (VA 0.3 OS). In addition to an afferent pupillary defect OS and a constricted visual field OS, an inter-eye latency difference was demonstrated in the visually evoked potentials. The patient was treated with megadose steroid therapy. Although periocular pain as a classic symptom was absent, no neuroradiological imaging was performed. Six weeks later visual acuity and visual fields further worsened, such that a nuclear magnetic resonance imaging was indicated revealing a meningioma fronto-basally compressing the optic nerve. After neurosurgical intervention visual acuity and field stabilized.


CONCLUSIONS
In rare cases, meningioma may mimic the symptoms of neuritis. Therefore, neuroradiological imaging is indicated in recurrences or complicated disease courses, particularly if classic symptoms such as periocular pain are missing.
Remky
A
A
Augenklinik des Universitätsklinikums der RWTH Aachen. andreas.remky@post.rwth-aachen.de
Korinth
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MC
D000284:Administration, Oral; D000328:Adult; D003937:Diagnosis, Differential; D004596:Electroretinography / Q000187:drug effects; D005074:Evoked Potentials, Visual / Q000187:drug effects / Q000502:physiology*; D005133:Eye Movements / Q000187:drug effects / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007275:Injections, Intravenous; D008279:Magnetic Resonance Imaging; D008577:Meningeal Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D008579:Meningioma / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D009408:Nerve Compression Syndromes / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D009901:Optic Nerve Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D009902:Optic Neuritis / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D010147:Pain Measurement; D011239:Prednisolone / Q000008:administration & dosage / Q000031:analogs & derivatives*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D011930:Reaction Time / Q000187:drug effects / Q000502:physiology; D012008:Recurrence; D014787:Vision Tests; D014794:Visual Fields / Q000187:drug effects / Q000502:physiology
D011239:Prednisolone; C021322:prednisolone hemisuccinate