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   Table of Contents      
ARTICLES
Year : 1974  |  Volume : 22  |  Issue : 2  |  Page : 40-41

Varicella encephalitis with cortical blindness


Department of Medicine, Medical College, Aurangabad-431001, India

Correspondence Address:
S Ashrafuddin
Department of Medicine, Medical College, Aurangabad-431001
India
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Source of Support: None, Conflict of Interest: None


PMID: 4461695

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How to cite this article:
Ashrafuddin S, Talib S H, Singh D, Maria D L. Varicella encephalitis with cortical blindness. Indian J Ophthalmol 1974;22:40-1

How to cite this URL:
Ashrafuddin S, Talib S H, Singh D, Maria D L. Varicella encephalitis with cortical blindness. Indian J Ophthalmol [serial online] 1974 [cited 2020 Apr 9];22:40-1. Available from: http://www.ijo.in/text.asp?1974/22/2/40/31366

Varicella may account for a number of neurological complications. Incidence of neurological complications with measles is 1:1000 and with small-pox it is 1:2000. [1] Exact incidence of neurological complications as­sociated with varicella is not known but they are comparatively less common. Post infec­tious encephalitis forms 90 percent of neuro­logical complications, 35 percent of which are manifested as cerebellar ataxia. Other neuro­logical manifestations include the Gullain­-Barre syndrome, transverse myelitis and aseptic meningitis.

Ocular complications following varicella includes conjunctivitis, vesicular lesion of conjunctiva, ulceration of the cornea and superficial punctate keratitis. [5] As in other encephalomyelits, varicella may give rise to ptosis, cranial nerve palsies, optic neuritis with varying degree of blindness, nystagmus and optic atrophy. [5]

In this article a case of cortical blindness following varicella encephalitis is being reported.


  Case Report Top


A 5 years old female child, presented at the infec­tious diseases out patient department, medical college Aurangabad, with complaints of skin eruptions all over the body for six days and bilateral total blindness of three days duration.

Six days prior to the admission the patient was well, when she developed fever with skin eruptions all over the body, characteristic of chicken-pox. She developed sudden bilateral blindness after three days and started behaving abnormally. She had focal convulsions of grandmal type of epilepsy on the right side of the body.

Examination at the time of admission revealed an irritable child, who resisted examination. There was confluent vesicular rash all over the body. General physical examination was within normal limits. Neuro­logical examination revealed an aggressive and irritable child. There was no evidence of meningitis. Superficial and deep reflexes were intact with flexor plantar response. Rest of the systemic examination was normal. Pupils were normal in size and reacted to light. Visual acuity was completely lost with no perception of light. Eye ball movements were normal and not painful. Fundus examination revealed no abnormality. All routine investigations were within normal limits. No specific treatment was given. Vision improved to perception of light one week after the onset, remained low for ten days and then returned to normal within four weeks.


  Discussion Top


The essential features of cortical blindness as outlined by Morquis [2] are; i) complete loss of all visual sensations including appreciation of light. ii) loss of reflex lid closure to bright illumination or to threatening gestures. iii) retention of reflex constriction of pupil to illumination and convergence movement. iv) integrity of the normal structure of retina and v) retention of normal motility of the eyeball. All the above mentioned features were present in this case.

Pathology of vericella encephalitis is similar to that of post measles encephalitis [5] . A different pathological picture may also be seen resembling that of post vaccinial encephalo­pathy with oedema and acute neuronal damage without demyelination. [3] Prognosis of encepha­litis from ophthalmological view point is better as compared to encephalitis following measles. [4]


  Summary Top


A case of post varicella encephalitis with bilateral, complete cortical blindness in a five year old girl, who recovered completely, has been reported. This is perhaps the first case with such a complication encountered so far.


  Acknowledgement Top


We are thankful to the Dean, Medical College, Aurangabad, for his permission to publish this paper.

 
  References Top

1.
Hoeprich, P.B., 1972, Infectious diseases, 1 edi­tion, 825-834.  Back to cited text no. 1
    
2.
Morquis, D.G., 1932, Quoted by Walsh, F.B., 1957, Clinical Neuroophthalmology, II edition, 54.  Back to cited text no. 2
    
3.
Mc Nair Scott, T. F., 1967, M. C. N. A., 51, 701.  Back to cited text no. 3
    
4.
von Bogaert, L., 1933, Rev. Neurola., 150, Quoted by Walsh, F.B. 1957.  Back to cited text no. 4
    
5.
Walsh, F.B., 1957, Clinical Neuroophthalmology, II edition, 474.  Back to cited text no. 5
    




 

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Acknowledgement
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