A 28-year-old caucasian woman presented to the emergency room with a history of a pressure-type frontal headache during the previous week; there was no exacerbation when lying down nor with Valsalva maneuvers and no accompanying features, namely, visual symptoms. Medical history was unremarkable except for venous thrombosis on her left leg 5 years before. She was not taking any drugs other than oral contraceptives. She had a son who was diagnosed with chickenpox two weeks before. She was febrile (temperature of 38°C), and there was a rash suggestive of chickenpox. Uncorrected visual acuity was 20/20 in both eyes, and the optic discs were swollen and hyperemic, with ophthalmological and neurological examinations otherwise normal. Two days later, she complained of ocular pain on eye movement and bilateral blurred vision. By that time, examination revealed reduced visual acuity of 20/32 in her right eye (OD) and 20/60 in her left eye (OS) and relative afferent pupillary defect on her left eye. She reported a difference in brightness of the red color, with less saturation in the left eye.\nRoutine blood testing and immunological workup (ANA, ANCA, anticardiolipin antibodies, and complement levels) were normal. HIV serology was negative as well as VDRL, Toxoplasma, Bartonella, and Borrelia antibodies.\nCerebral computed tomography (CT) scan and magnetic resonance imaging (MRI) were normal.\nCerebrospinal fluid (CSF) examination was unremarkable: clear fluid with a normal opening pressure of 130–140 mm H2O with no block when pressing the jugular vein, normal protein and glucose levels, less than 5 leukocytes, and no oligoclonal bands. Antibodies for the following microorganisms were negative in the CSF: Cytomegalovirus, Epstein Barr virus, Parvovirus, Herpes simplex virus, Varicella zoster virus, Mycoplasma pneumoniae, Borrelia burgdorferi, and Leptospira species. VDRL was also negative in the CSF.\nGoldmann perimetry showed an enlarged blind spot and constriction of the nasal field, especially in her left eye (). Farnsworth Munsell 100 color vision test was abnormal in both eyes (in the red axis), with more pronounced defect in her left eye.\nShe was started on acyclovir 4 g/day per os, as is indicated to treat adult chickenpox.\nTwo days after the initial visual symptoms, visual acuity began to increase, and one week later, the optic disc edema had almost resolved (). Visual acuity continued to improve, and two months later, she had a visual acuity of 20/20 bilaterally. Retinal fluorescein angiography one month after presentation was normal. She has been free of further attacks of optic neuritis for three years after the admission.
A 45-year-old woman suffering from intraocular hemorrhage associated with chronic myeloid leukemia complicated by subdural hematoma was referred to our institution. Chronic myeloid leukemia had been diagnosed 10 years earlier and the patient’s comorbidities were treated arterial hypertension, hepatitis B virus positivity, and orally treated type 2 diabetes mellitus diagnosed 3 years earlier. At presentation, she was in blast crisis for the second time and the disease was rapidly progressing. She was hospitalized in the Hematology-Oncology Department, University of Turin, with a very low platelet count (8,000/mm3) and red cell count (2,000 mm3), asthenia, fever, and occipital headache radiating to the anterior parts. A severe subdural hematoma was discovered, with ventricular dilatation and signs of high intracranial pressure. She was treated with repeated platelet transfusions and conservative medical therapy. The patient’s condition improved slowly, with progressive reabsorption of the hematoma and normalization of ventricular morphology on brain computed tomography scan.\nWe followed up this patient for a year by assessment of visual acuity, fundus examination, color retinography, and A-scan and B-scan ultrasonography. The patient complained of visual impairment in the left eye since the onset of her neurological symptoms, and was referred to our clinic. At presentation, her best corrected visual acuity on the right was 20/63 and on the left was 20/320. Retinal examination of the right eye revealed blurring of the optic margins surrounded by retinal and preretinal hemorrhages, preretinal fibrosis starting from the optic disc and extending along the vascular arcades, and perivascular retinal infiltrates (). Massive fibrosis with hard exudates and severe preretinal hemorrhage were observed in the left eye at the posterior pole (). The optic disc was surrounded by retinal and preretinal hemorrhages. Roth spots and many circular and preretinal hemorrhages were noted at the retinal periphery (). The other ocular structures were within normal limits. Ocular tension was good (right, 20 mmHg; left, 17 mmHg).\nA-scan and B-scan ultrasonography showed similar clinical features in both eyes, ie, an anechogenic vitreous cavity, a small increase in the thickness of the chorioretinal complex, and some minute retinal lines with higher reflectivity, likely representing hemorrhages. The patient was monitored for 12 months, with no changes in her clinical and functional characteristics.