Neuroretinitis with coexistent Bell's Palsy

ABSTRACT

AlMTo report an unusual case of neuroretinits with coexistent Bell's Palsy.

METHODS:

A 16-year-old boy presented with right eye blurring of vision for one week. It was associated with high fever and facial asymmetry. The visual acuity of the right eye was 6/60 and the left eye was 6/6. Funduscopy of the right eye showed swollen and hyperemic optic disc with presence of macular star. There was also left lower motor neuron nerve palsy. Humphrey visual field perimetry showed small paracentral scotoma with enlargement of blind spot. Complete blood count showed neutrophilia with increased erythrocyte sedimentation rate (ESR). Serology for syphilis, toxoplasmosis, Lyme disease and cat-scratch disease was negative. Herpes simplex virus, Herpes zoster virus, and human immunodeficiency virus investigations were negative. Rickettsia was also negative. MRI of the brain and orbit were normal without demyelinating lesion. He was started with high dose intravenous methylprednisolone 250mg four times per day for three days. He was then discharged home with oral prednisolone 1mg/kg for another 11 days. During the follow-up,the visual acuity was improved to 6/6 after six months with slightly pale disc.The Bell's palsy was also improved without obvious facial asymmetry.

It is important for clinician to examine other cranial nerces in optic neuritis. Although neuroretinitis with coexistent facial nerve in optic neuritis.Although neuroretinitis with coexistent facial nerve palsy is a rare conditon,thorough examinations and investigations should be made to exclude the inportant infetice causes.Optic neuritis with coexistent facial nerce palsy responds well to the high dose steroids.