PMC3605106_01
Left eye at presentation. (A) Fundoscopy reveals swelling of the left optic disc. (B) Reduced peripheral sensitivity detected in a visual field test. (C) OCT quantifying the oedema in the left optic disc. Note the RNFL thickening in all quadrants and in 11 of 12 RNFL sectors. (D) Audiometry of the left ear indicating impaired sound transmission both through the air and bone. The greater effects observed for the higher frequencies are diagnostic of sensorineural deafness.
1869-5760-3-27-1.jpg
PMC3605106_01_1869-5760-3-27-1.jpg
F1
Fundoscopy revealed swelling of the left optic disc (Figure 1A), with no abnormalities detected in the right eye (RE). A visual field test proved normal for the RE, while the LE showed reduced peripheral sensitivity (Figure 1B). OCT of the LE revealed considerable retinal nerve fibre layer (RNFL) thickening in all quadrants and in 11 of 12 RNFL sectors (Figure 1C). Audiometry of the left ear revealed impaired sound transmission both through the air and bone, with greater effects observed for the higher frequencies (Figure 1D), and a diagnosis of sensorineural deafness was made.
Three weeks after treatment with intravenous penicillin. (A) Fundoscopy reveals the absence of oedema in the left optic disc. (B) Left eye visual field test is normal. (C) Normal OCT-determined RNFL thickness indicates resolution of the oedema. (D) Audiometric test results for the left ear are normal.
1869-5760-3-27-2.jpg
PMC3605106_01_1869-5760-3-27-2.jpg
F2
T cell count was still over 350 cells/mul. Three weeks after initiation of treatment and 3 months after the onset of symptoms, fundoscopy revealed the absence of oedema in the left optic disc (Figure 2A), and VA was 20/20 in both eyes. Perimetry was normal (Figure 2B), and OCT-determined RNFL thickness was within the limits of normality (Figure 2C). The patient reported a marked improvement of hearing in his left ear, which was confirmed by audiometry (Figure 2D).