Neuroretinitis, a great mimicker

Abstract

Neuroretinitis is a less-known clinical entity, which can be funduscopically confused with papillitis or papilledema and with hypertensive, renal and infiltrative retinopathies as well as with retinal vein occlusion or anterior ischemic optic neuropathy.Report:Two young patients presented with sudden onset of blurring of vision. Ophthalmic evaluation revealed a characteristic picture of neuroretinitis. Detailed study of the cases failed to indicate any specific etiology, thereby suggesting the diagnosis of idiopathic neuroretinitis. Although funduscopy showed marked inflammatory changes in the retina and optic nerve head, the recovery following medical treatment was remarkable.Comment:Familiarity with the fundus picture and awareness of the specific causes of neuroretinitis among neurologists and physicians may enable a prompt clinical diagnosis, avoidance of expensive brain imaging studies and early referral for appropriate and effective therapy. A brief review of the literature is presented suggesting a need for further studies to establish specific environmentally determined etiological factors such as infections and the effectiveness of the current modalities of treatment.

An unusual cause of visual impairment in tuberculous meningitis

“…The differential diagnosis of neuroretinitis, especially in view of painless loss of vision and the ophthalmoscopy findings, involves papilledema, central retinal vein obstruction and central retinal artery obstruction [13,14]. In the case presented, there was no evidence of raised intracranial pressure on CSF manometry and imaging, or vascular abnormalities on fluorescein angiography which supports the diagnosis of neuroretinitis.…”

“…Cat scratch disease is the most common infectious cause of neuroretinitis; other important causes include syphilis, Lyme's disease, herpes, mumps and leptospirosis. Management is essentially by treatment of the underlying cause; steroids or immunosuppressants may be used in recurrent cases [13,14].…”

Final Diagnosis in Patients Referred with a Diagnosis of Neuroretinitis

“…These include branch retinal vein occlusion, diabetic papillopathy, idiopathic intracranial hypertension, anterior ischaemic optic neuropathy, posterior vitreous traction, disc and juxtapapillary tumours including angioma, melanocytoma, and melanoma, and infiltrative and toxic optic neuropathy. 2,8 The patient's history and a careful analysis of clinical findings associated with ODOMS can help to establish the definitive diagnosis.…”

Neuroretinitis as an Unusual Manifestation of Leptospirosis: A Case Report

“…Infections like syphilis, tuberculosis, cat-scratch disease, lyme disease, hepatitis B, mumps, measles, toxoplasmosis and cysticercosis may cause neuroretinitis. Leptospirosis is also included in the list [7,8]. Leptospirosis presents with both systemic and ocular manifestations.…”