Initial Diagnostic Dilemma with 3 Neuro-Ophthalmic Cases Seen at University of Port Harcourt Teaching Hospital, Nigeria

Abstract

Aim: The aim is to present three patients with neuro-ophthalmic symptoms and signs who initially presented a diagnostic dilemma. Two later turned out to be retroviral positive. Presentation of Cases: CASE 1 was a 35 yo female nurse assistant who first presented with a-one month history of deep-seated pain in the right eye, right side of face and headache with sudden onset diminished vision in the right eye. She was initially diagnosed with optic neuritis but this was followed 7 months later with panuveitis and bullous RD. Patient was not hypertensive or diabetic and was retroviral (RV) negative. Even though she presented a diagnostic dilemma, a tentative diagnosis of recurrent idiopathic neuro-retinitis is entertained on account of the clinical features and normal investigations. CASE 2 was a 32yo female who presented on account of sudden onset binocular horizontal diplopia of 2 weeks duration. She later developed dizziness and paraesthesia of the left side of her body and examination revealed bilateral torsional nystagmus. The patient was HIV positive with a CD4+=39 cells/μl. The third Case was a 17yo student initially diagnosed with Bell’s palsy but later developed transient visual loss. He was found to be HIV positive with a CD4+= 768 cells/μl. Conclusion: These 3 cases bring to the fore the importance of entertaining a high index of suspicion in managing unusual cases that present to the ophthalmologist; and in all cases to rule-out HIV/AIDS since it has its highest prevalence in sub-Saharan Africa. That way, early intervention can be instituted and this would ultimately reduce morbidity and mortality from the disease.