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High-dose intravenous corticosteroids are effective in treating acute optic neuritis.1
However, certain ophthalmological conditions should be considered before treatment as they can be worsened by corticosteroids: this emphasises the need for collaboration between neurologists and neuro-ophthalmologists.2 ,3
A 47-year-old man presented in 1999 with right-sided optic neuritis. This was treated with intravenous corticosteroids and he made a good recovery, with post-treatment visual acuity of 6/6. Between 1999 and 2004, he had several episodes of sensory symptoms, not requiring treatment. Imaging corroborated the clinical diagnosis of multiple sclerosis4 and he was treated with weekly interferon ß1a (Avonex) 30 µg. In 2005, he presented with a left optic neuritis, treated by high dose corticosteroids and again with good ophthalmological recovery. Unfortunately, in 2006, he began to develop a progressive paraplegia. He then presented with bilateral impairment of vision, with decreased visual acuity to 6/19 (right) and 6/9.5 (left). He did not undergo dilated fundus examination. He also reported worsening of the motor symptoms and sphincter disturbance. Intravenous high-dose corticosteroids treatment was started and, despite the treatment, he reported a painless decrease of visual acuity in the right eye, with a scotoma resembling a …
Contributors MS, individual contribution to the manuscript—Drafting, revising, conducting and reporting the manuscript's content, including medical writing of content. AD, individual contribution to the manuscript—Drafting, revising and planning the manuscript's content, including medical writing of content. BP, individual contribution to the manuscript—Drafting and reporting the manuscript's content. SAF, individual contribution to the manuscript—Revising the manuscript's content, including medical writing of content. DB-G, individual contribution to the manuscript—Conducting and revising the manuscript's content, including medical writing of content. MS and AD, are responsible for the overall content as guarantors.
Competing interests None.
Provenance and peer review Not commissioned. Externally peer reviewed. This paper was reviewed by Mark Lawden, Leicester, UK.