We present a paediatric case of infectious mononucleosis in a 13-year old, manifesting with follicular conjunctivitis and a conjunctival mass in one eye with no evidence of leucocytosis on the blood count. The diagnosis was confirmed following surgical excision and biopsy. The case represented a diagnostic challenge due to its atypism and given the steady increase in the prevalence of EBV-related ocular diseases in the last years, this report can serve as an example to prompt earlier serological tests to identify the aetiology in similar cases. This is important because EBV can be treated with acyclovir early in the active viral phase.

Neurofibromatosis 2 (NF2) is a rare autosomal dominant disorder associated with the development of multiple central and peripheral nervous system tumors. Patients with NF2 are often diagnosed in adulthood, with symptoms of an isolated tumor or hearing loss associated with vestibular schwannomas. Diagnosing NF2 in children is complicated by the fact that the diagnostic criteria often are not met at presentation and there is usually no family history of the disease. The authors describe the diagnostic challenge posed by a pediatric patient who developed a relapsing and remitting third nerve paresis and was later diagnosed with NF2. A mechanism for the recurrent cranial mononeuropathy is proposed.

The Optic Neuritis Treatment Trial previously reported that corticosteroids accelerated visual recovery in optic neuritis (ON) without improving outcome. This finding related largely to multiple sclerosis (MS), and subsequently neurologists tended to await spontaneous recovery in ON. Since then, non-MS cases of ON have been identified with antibodies to aquaporin-4 (AQP4) or myelin oligodendrocyte glycoprotein (MOG). These disorders can closely mimic multiple sclerosis-associated or idiopathic demyelinating optic neuritis (MS/IDON) initially but risk a worse visual outcome. Scrutinising the clinical features and neuroimaging often enables differentiation between MS/IDON and other causes of ON. Early treatment with high-dose corticosteroids is an important determinant of visual outcome in non-MS/IDON. Prompt use of plasma exchange may also save sight. In this review, we contrast the presentations of myelin oligodendrocyte glycoprotein associated optic neuritis (MOG-ON) and aquaporin 4 associated optic neuritis (AQP4-ON) with MS/IDON and provide an approach to acute management while awaiting results of antibody testing.

ResultsOf the 965 vEEGs undertaken during the study period, 103 were performed following a first unprovoked epileptic seizure (median age: 7 years; range: 1 month-17 years). Out of 103, 18 had neurodevelopmental problem, 21 had a family history of epilepsy and 14 of prior febrile seizure. Seizure semiology included tonic-clonic, (n=52), focal (n=12), focal with secondary generalization (n=16), autonomic (n=6), atonic (n=1), myoclonic (n=1), and uncertain (n=15) seizure types. vEEG outcomes included normal (n=50, 48.5%), nonepileptic events recorded (n=6, 5.8%), and suggestive of an epilepsy syndrome (n=47, 45.6%). Excluding the 6 patients with non-epileptic events, the remaining 97 were divided into two sub-groups (Group A: 1 month to 12 years[n-74], Group B: 12 years -17 years [n-23]). Epilepsy syndrome identified: Group A -41%, Group B -71%. In group B, EEG was supportive of epilepsy syndrome in 17 (73.9%) Table 1. Abstract G184(P) Table 1 EEG value outcome in our series