were all normal, whereas PCR for HSV1 and 2, EBV, and CMV were all negative. LP was normal with an opening pressure of 14 mm Hg. An MR scan showed a number of peri-ventricular high-signal lesions. He was diagnosed with ADEM and optic neuritis, and treated with two doses of intravenous methyl-prednisolone followed by a reducing dose of oral prednisolone. He has made a good recovery with improved vision to 6/6 in his left eye, resolution of optic nerve swelling, and reabsorbing peri-papillary haemorrhages (Figure 1b). His right eye remains quiescent and there have been no further neurological or ophthalmic episodes.
CommentTo the best of our knowledge, this is the first report of ADEM with peri-papillary haemorrhages. This observation raises the question as to the underlying aetiology and although an autoimmune mechanism with HLA-DR linkage is likely, other forces may have a role to perform. 4,5 Further work is required to ascertain the possibility of a vasculitic element to the underlying processes.
Conflict of interestThe authors declare no conflict of interest.