Encephalitis followed by optic neuritis: A case report and review of literature

Abstract

Encephalitis has been included in the causes of optic neuritis, but post encephalitic optic neuritis has been rarely reported. Majority of the cases of optic neuritis are either idiopathic or associated with multiple sclerosis, especially in western countries. This is very important in the Asian population where the incidence and prevalence of multiple sclerosis is not as high as in the Western countries. Although post infectious optic neuritis is more common in children, it can also be found in adults and is usually seen one to three weeks after a symptomatic infective prodrome. Here, we present a case of a 48 year-old-male who developed optic neuritis following viral encephalitis. His first presentation was with severe headache of two weeks duration. Viral encephalitis was diagnosed and treated. The patient presented again three weeks later with right eye pain and other features typical of optic neuritis. Corticosteroid therapy facilitated prompt recovery. Optic neuritis is an uncommon manifestation of encephalitis. It is important that both doctors and patients remain aware of post infectious cause of optic neuritis, which would enable a timely diagnosis and treatment of this reversible cause of vision loss.

Bilateral Optic Neuritis Associated with Central Nervous System Infection in an Adult

“…Intravenous corticosteroids have been effective in most optic neuritis patients. [1][2][3][4]8 When infectious optic neuropathy is suspected, as in this case, it is helpful to use antiviral drugs and steroids with caution. 8 In conclusion, it is very important for the clinician to perform the necessary tests and initiate appropriate treatment as soon as possible for patients with visual impairment of unknown cause.…”

“…Only a few cases of optic neuritis post-encephalitis have been reported in the recent years. 3,4 Cases of optic neuritis accompanying encephalitis and meningitis are even more rare. We would like to present a case report of bilateral optic neuritis, which is suspected to be related to CNS infection in an adult.…”

Herpes Simplex Virus 2 Meningoencephalitis-Associated Bilateral Optic Neuritis and Radiculitis

“…2 To our knowledge there have only been two case reports of HSVassociated optic neuritis in the literature. 3,4 One case was with HSV-1 4 while the patient refused lumbar puncture in the other case. 3 Most of the literature describes acute retinal necrosis as the complication of HSV encephalitis.…”

“…3,4 One case was with HSV-1 4 while the patient refused lumbar puncture in the other case. 3 Most of the literature describes acute retinal necrosis as the complication of HSV encephalitis. 2 Antivirals alone did not prevent the rapid progression of our patient's visual symptoms, and the fact that it was successfully treated with corticosteroids and IVIG suggests an inflammatory or possible autoimmune process rather than direct viral infiltration of the optic nerve.…”

A Case of Terson-Like Syndrome in a Patient with Viral Meningoencephalitis

“…Viral meningoencephalitis is typically associated with fever, headache, photophobia, and neck stiffness whereas viral encephalitis is associated with fever, seizures, focal neurologic deficits, and decreased consciousness [9]. Thus far, the only reported ocular complications linked to viral meningoencephalitis include sixth nerve palsy, optic neuritis, and papilledema [10–12]. We describe a case of viral meningoencephalitis with multilayered retinal hemorrhages suggestive of a Terson-like syndrome.…”