[Bilateral simultaneous acute amaurosis in neuritis nervi optici. Initial manifestation of encephalomyelitis disseminata].

BACKGROUND:Bilateral simultaneous acute amaurosis as a primary manifestation of demyelinating disease is extremely rare. PATIENT:The clinical course of a 24-year-old patient who initially presented with a bilateral complete loss of vision is demonstrated. Morphologically both optic discs appeared slightly blurred and prominent. Otherwise there were no anterior and posterior segment abnormalities. Examination of the cerebrospinal fluid revealed an increased number of cells and protein without oligoclonal bands. On MRI multiple white matter lesions were visible. Laboratory tests showed no specific abnormalities, especially with respect to infectious or vasculitic diseases. Under intensive steroid therapy (initially 1000 mg prednisolone/day), visual acuity recovered almost completely. Nine months after onset of the disease visual acuity was 1.0 in both eyes. CONCLUSIONS:Even in patients with a fulminant onset of the disease almost complete visual recovery is possible. Differential diagnosis should rule out vasculitic autoimmune optic neuritis, infections, tumors, processes of the paranasal sinuses, toxic, and hereditary causes.