Systemic Disorders With Optic Nerve and Retinal Findings

Update item information
Identifier 96_48
Title Systemic Disorders With Optic Nerve and Retinal Findings
Subject Syphilis
Description A 42-year old woman presented with a history of severe brow pain and 4 days of progressive visual loss OD. There was no increased pain on ocular rotation. Aside from heavy menses, she denied any significant past medical history. Her examination revealed acuity NLP OD, 20/25 OS; color vision 9/10 OS; pupils amaurotic OD, RRL OS, +3 APD OD; motility normal, slit-lamp examination and IOP normal OU; visual field mild generalized constriction and nasal step OS. Neurologic examination normal; funduscopic examination bilateral hyperemic disc edema, OD>>OS. The MRI of the head was normal. That night, she underwent a spinal tap that showed an opening pressure of 300, 5 white cells, protein = 30, and serology, cultures, and gram stain all negative. MRI of the orbits with fat suppression revealed enhancement of the right optic nerve and streaky enhancement of the orbital fat, consistent with optic neuritis/perineuritis. Her RPR returned later that day, and was +1:32, with a positive FTA-ABS. Her hemoglobin was 6.5, with a platelet count of 701,000. She had hypochromic -microcytic indices and was felt by the hematology specialist to have severe iron deficiency anemia. She was treated with 2 grams IV penicillin q4h for 14 days with concomitant Solu-Medrol 250 mg IV q6h for 3 days. Her pain resolved within 6 to 12 hours, and her vision recovered to 20/20 OU. She refused HIV testing and any subsequent blood work. Imaging: MRI axial 2. Disease/Diagnosis: Syphilitic optic neuritis/perineuritis.
Creator AAO/NANOS - American Academy of Ophthalmology / North American Neuro-Ophthalmology Society
Publisher Spencer S. Eccles Health Sciences Library, University of Utah
Type Image
Format image/jpeg
Relation is Part of Case 51
Rights Management Copyright 2002. For further information regarding the rights to this collection, please visit:
Holding Institution North American Neuro-Ophthalmology Association. NANOS Executive Office 5841 Cedar Lake Road, Suite 204, Minneapolis, MN 55416
Collection Neuro-ophthalmology Virtual Education Library: NOVEL
Contributor Primary Larry P. Frohman, MD, UMDNJ-New Jersey Medical School
References Frohman LP, Wolanski L: Magnetic resonance Imaging of Syphilitic Optic Neuritis/Perineuritis. J Neuro-Ophthalmol 1997;17:57-59
Source AAO/NANOS Clinical neuro-ophthalmology : image collection for ophthalmic practitioners. American Academy of Ophthalmology [electronic resource], [San Francisco, Calif.] : AAO, c1999.
ARK ark:/87278/s6m07518
Setname ehsl_novel_aao_nanos
Date Created 2005-06-27
Date Modified 2021-08-12
ID 177024
Reference URL