A Sudden Visual LossWe admitted to our department M., a 8 years old girl, for sudden bilateral vision loss. The onset of visual symptoms had been preceded by an important and self-healing headache. A bilateral papilledema was detected, with the evidence of a severe impairment of visual acuity. Laboratory blood tests were normal, except for ANA positivity. Optic nerve transorbital sonography and Brain Magnetic Resonance (MRI) revealed bilateral thickening of the optic nerves in the retrobulbar tract. The Cerebrospinal Fluid (CSF) examination was normal and the oligoclonal bands were negative. Serology tests revealed Anti-MOG antibodies negativity, while anti-AQP4 antibodies were positive. Based on clinical, laboratory and MRI findings, diagnosis of Optic Neuromyelitis (NMO) was made. NMO is an inflammatory demyelinating disease of the Central Nervous System (CNS), based on an autoimmune pathogenesis. It is traditionally characterized by optic neuritis and transverse myelitis. First line therapy is based on high dose pulse steroids; in case of treatment failure, second-line therapy with Therapeutic Plasma Exchange (TPE) can be proposed.

We describe the case of a 9-year-old male patient who was admitted for seventh cranial nerve palsy occurred after seven days of frontal headache. The emergency cranial CT scan was negative. For the persistence of symptoms and the onset of vomiting and nystagmus we performed encephalic contrast MRI and MR angiography. The MRI findings were consistent with the McDonalds radiological diagnostic criteria for Multiple Sclerosis (MS), confirmed by the oligoclonal bands positivity in cerebrospinal fluid (CSF). In childhood MS is a rare disease and the clinical onset is variable. Seventh cranial nerve palsy is a very rare first clinical sign of MS and the association between MS and seventh nerve palsy have been rarely reported in literature. As evident in our case, seventh cranial nerve palsy, particularly when associated with other neurological signs and symptoms, should not be underestimated by the clinicians.