title: Presumed infective meningoencephalitis complicated by bilateral optic neuritis.
abstract: OBJECTIVE
  To report a case of presumed infective meningoencephalitis complicated by bilateral optic neuritis.
  
  
  METHODS
  Interventional case report.
  
  
  RESULTS
  A 7-year-old Pakistani girl presented with fever and multiple right-sided focal seizures. Despite empirical treatment with antibiotic, anti-viral and anti-tuberculous therapy for presumed infective meningoencephalitis, she further deteriorated, developing altered consciousness, hemiplegia and severe, bilateral optic neuritis. No infectious agent could be identified. Following the addition of high dose systemic corticosteroid therapy, her optic nerve function in both eyes began to recover. At 3-month follow-up, the hemiplegia had completely resolved, and visual acuity was 6/6 bilaterally with normal pupillary responses.
  
  
  CONCLUSIONS
  This case demonstrates that meningoencephalitis of presumed infective origin may be complicated by acute, severe, bilateral optic neuritis, the latter often mediating profound visual loss. In the setting of rapidly deteriorating vision, aggressive corticosteroid treatment, with antimicrobial cover, albeit unproven, remains the mainstay of treatment.
authors.affiliation: Department of Ophthalmology, Great Ormond Street Hospital, London, UK. danielmgore@gmail.com
authors.forename: D M
authors.initials: DM
authors.lastname: Gore
authors.forename: G D
authors.initials: GD
authors.lastname: Hildebrand
authors.forename: R
authors.initials: R
authors.lastname: Sekhri
authors.forename: P
authors.initials: P
authors.lastname: Nicolaides
authors.forename: J
authors.initials: J
authors.lastname: Leitch
mesh_terms: D002648:Child; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008279:Magnetic Resonance Imaging; D008590:Meningoencephalitis / Q000150:complications* / Q000175:diagnosis; D009902:Optic Neuritis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*
chemical_list: D005938:Glucocorticoids