|Year : 1975 | Volume
| Issue : 2 | Page : 20-22
Optic neuritis due to demyelinating disease
GC Sood, Shashi Kapoor, V Anand Rao, Gyanam Krishnamurthy, S Ramakrishnan, Rajisamy
Jawaharlal Institute of Post-Graduate Medical Education and Research, Pondicherry-6, India
G C Sood
Professor of Ophthalmology, J.M.P.E.R, Pondicherry 6
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sood G C, Kapoor S, Rao V A, Krishnamurthy G, Ramakrishnan S, Rajisamy. Optic neuritis due to demyelinating disease. Indian J Ophthalmol 1975;23:20-2
|How to cite this URL:|
Sood G C, Kapoor S, Rao V A, Krishnamurthy G, Ramakrishnan S, Rajisamy. Optic neuritis due to demyelinating disease. Indian J Ophthalmol [serial online] 1975 [cited 2020 Apr 6];23:20-2. Available from: http://www.ijo.in/text.asp?1975/23/2/20/31325
Demyelinating conditions have been diagnosed very infrequently as an etiological factor for various neurological disorders in India. This is, because the typical triad of Charcot is hardly seen.  A presumptive diagnosis of Disseminated Sclerosis in paraplegics, has already been reported ,,,, .
This case is being reported since there were a wide range of systemic and ocular findings suggestive of Disseminated Sclerosis.
| Case Report|| |
Patient PN, aged 35 years, male, reported for the first time in March 1973, for weakness in his right side of the body. Neurological examination revealed generalized hypotonia. Joint sense in left lower limb was reduced. Romberg's sign was positive and finger nose test showed past-pointing. Superficial as well as deep sensations in right half of the body were absent. He was put on steroids and the condition improved remarkably.
In April 1974, he developed marked degree of hypotonia and loss of power in both the lower limbs (Grade IV). Superficial and deep sensations were absent on the medial side of right upper limb and lateral side of both the thighs. Joint sense was impaired in lower limbs. Romberg's sign was positive and the deep reflexes were sluggish.
In January 1975, the patient experienced sudden loss of vision in right eye for the first time. Neurological examination revealed generalized hypotonia with normal muscle power. Intention tremors more marked on the right side were seen. Finger nose test and the heel knee test showed incordination on the right side. Romberg's sign was positive. He walked keeping his legs extended. All the deep reflexes were sluggish. Ocular Examination revealed loss of voluntary wrinkling of forehead, with superior gaze palsy. Pupils were sluggish but were reacting normally to accommodation and convergence. Vision in the right eye was reduced to perception of light with defective projection in two quadrants. Fundus showed temporal pallor of the optic nerve head, a healed patch of chorioretinitis and vascular sheathing on the temporal side. Left eye was having a visual acuity of 6/5, normal fundus but a centroceacal scotoma [Figure - 1] After making him walk for 50 metres, the visual acuity in left eye fell to 6/18 and the fields showed marked degree of constriction which included the previous scotoma [Figure - 2]. All investigations for blood, VDRL and X-Ray chest, spine and skull were normal. CSF showed marked rise in gamma globulins [Figure - 3]. The vision in right eye improved to 6/18 in temporal quadrant with steroids [Figure - 4].
| Discussion|| |
A clinical diagnosis of Disseminated Sclerosis demands documentation of multiple lesions unexplained by any other agent. The case presented, shows wide range of signs involving cerebellum, sensory system, optic nerves and the gaze controlling mechanisms, unexplained by any single factor other than Disseminated Sclerosis. Further fall of visual acuity and the generalized constriction of fields after exercise goes in favour of the diagnosis of Disseminated Sclerosis. This phenomenon has been explained on the basis of reversible conductive block , . Retinal venous sheathing and peripheral uveitis seen in our case have also been reported earlier ,,,, .
| Summary|| |
An interesting case of Disseminated sclerosis with ocular and systemic findings is reported.
| Acknowledgment|| |
We are thankful to Dr. D.B. Bisht, Principal, Jawaharlal Institute of Post-Graduate Medical Education and Research, Pondicherry-6 (South India), for allowing us to publish this case.
| References|| |
Agarwal, K., Padmavati, S., and Singh, B., 1968, Neurology India, 12, 154.
Archambeau, P.L., Hollenhorst, R.W.. and Rucker, C.W., 1965, Proc. Mayo Clinic, 40, 544.
Bhargwa, H.S,, and Berry, J.N., 1961, J. Ass. Phys. India, 9, 212.
Breger, B.C., and Leopold, I.H.. 1966, Amer. J. Ophthal., 62,
Desai, A., 1955, Neurology India, 4, 213.
Frison, L., and Hoyt, W.F., 1974, Arch. Ophthal.,
Giles, C.L., 1970, Amer. J. Ophthal., 70, 17.
Huxley, A.F., 1959, Ann. N.Y. Acad. Sci.,81 221.
Jaba, P.N., and Johri, B.S. 1958, J. Ass. Phy India., 6, 263.
Jolly, S.S., Singh, J., and Singh, A., 1961,J Ass. Phys. India., 9, 13.
Misra, R.N., Tandon, P.N., and Lehiri, A.K .
1969, Neurology India., 12, 50.
Porter, R., 1972, Brit. J. Ophthal.,
Raminsky, M., 1973, Arch. Neurol., 28, 287.
Rucker, C.W., 1944, Proc. Mayo Clinic., 19,
Sathe, P.V., 1955, J. Ass. Phys. India., 3, 158.
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]