Bilateral Central Retinal Artery Occlusion Associated With Herpes Simplex Virus-Associated Acute Retinal Necrosis and Meningitis: Case Report and Literature Review

• Type of Material: Article
• Authors: Heather M. Weissman, Emory University; Valerie Biousse, Emory University; Marcos Coutinho Schechter, Emory University; Carlos Del Rio, Emory University; Steven Yeh, Emory University
• Language: English
• Date: 2015-02-01
• Publisher: Slack
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2016, Slack Inc.
• Final Published Version (URL): http://dx.doi.org/10.3928/23258160-20150213-24
• Title of Journal or Parent Work: OSLIRetina
• ISSN: 2325-8160
• Volume: 46
• Issue: 2
• Start Page: 279
• End Page: 283
• Grant/Funding Information: This work was supported in part by an unrestricted departmental grant from Research to Prevent Blindness (New York, NY) to the Emory Eye Center and an NEI Core Grant for Vision Research (P30 EY 006360)
• Keywords: Science & Technology; OPTIC NEUROPATHY; Life Sciences & Biomedicine; Surgery; Ophthalmology; DIAGNOSIS; ENCEPHALITIS
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Opthamology

Abstract

A 60-year-old woman with a history of recurrent headaches and blurred vision presented with bilateral optic disc edema. Optic neuritis was suspected, and intravenous methylprednisonlone was administered. Her vision declined to hand motions in both eyes, and subsequent evaluation revealed bilateral acute retinal necrosis with bilateral central retinal artery occlusions (CRAO). Aqueous humor polymerase chain reaction analysis was positive for herpes simplex virus (HSV), establishing a diagnosis of HSV-associated bilateral acute retinal necrosis (ARN) and meningitis. CRAO has rarely been reported in association with ARN, and a fulminant course with bilateral CRAO in association with ARN has not been previously reported. This case emphasizes the importance of careful peripheral examination in patients with presumptive optic neuritis, judicious use of systemic corticosteroid in this context, and the retinal vaso-obliterative findings that may be observed in the pathogenesis of ARN.