Dr.PARMITA DUTTA

Dr.Abhijit Kumar Handique

Abstract

Polyphasic presentation of optic neuritis is rare. A 49 year old female came with diminution of vision of R/E since 3 days,sudden in onset,gradually progressive in nature.

She was diagnosed as relapsing remitting multiple sclerosis with right optic neuropathy 2 months back,continued on Tab teriflunomide 14 mg once daily.

She had history of left optic neuropathy 3 years back.

V/A- R/E-HMCF,L/E-NPL, Pupillary reflex R/E-RRRL,L/E-RAPD grade 2.

Fundus-R/E-Optic Disc Edema(Frisen Grade 3),optic disc hyperemia,L/E-Optic atrophy.

MRI-mutifocal hyperintensity white matter lesions in bilateral fronto parietal , periventricular regions and optic nerve, suggesting Multiple sclerosis.

Treatment: Injection i.v methylprednisolone 1 gm for 3 days followed by Tab Wysolone 10 mg (1 mg/kgbw)tapered over 15 days with tab teriflunomide as before.

At 2months:V/A R/E-3/60,L/E-NPL

Fundus: Optic atrophy B/E with fibrosis and traction from optic disc in L/E.The patient has no episode of recurrence till now.