Subhyaloid Hemorrhage in a Case of Devic’s Disease

Abstract

A 14‑year‑old boy was admitted for paraplegia, acute urinary retention, and a sudden reduction in the visual acuity of both eyes. Fundus examination revealed bilateral optic neuritis with large subhyaloid hemorrhage in left eye. Cerebrospinal fluid examination showed mild pleocytosis and absence of oligoclonal band. Magnetic resonance imaging (MRI) revealed hyper intensity in T2‑weighted images along the spinal cord. No abnormality was detected in brain MRI. Visual evoked potentials were suggestive of bilateral optic neuropathy. He received intravenous pulse corticosteroids (methyl prednisolone) for 3 days followed by oral prednisolone. There was improvement in both the visual acuity and the systemic manifestations. We diagnosed the case as neuromyelitis optica (NMO) based on the examination and investigation findings. NMO or Devic’s syndrome is an uncommon clinical syndrome associating unilateral or bilateral optic neuritis and transverse myelitis. Subhyaloid hemorrhage, as an ophthalmic feature of NMO, has not been reported till date. We report this case so as to alert the clinician about this unusual presentation of NMO.

Keywords: Neuromyelitis optica, optic neuritis, subhyaloid hemorrhage, transverse myelitis