Samra and Ramtahal Journal of Medical Case Reports 2012, 6:15 http://www.jmedicalcasereports.com/content/6/1/15 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Recurrent subacute visual loss presenting in a 52- year-old Caucasian woman with chronic relapsing inflammatory optic neuropathy: a case report Amrit Samra* and Jason Ramtahal Abstract Introduction: Chronic relapsing inflammatory optic neuropathy is a recently described form of recurrent isolated subacute optic neuropathy. The condition is highly responsive to systemic steroid treatment and prone to relapse on steroid withdrawal. A complete work up for demyelination, autoimmune disease and sarcoidosis must be made before considering chronic relapsing inflammatory optic neuropathy. Case presentation: We describe the case of a 52-year-old Caucasian woman who presented with isolated subacute optic neuropathy. There was no evidence of demyelination, autoimmunity or sarcoidosis. There was an abrupt and prompt response to systemic corticosteroids and a relapse of the condition on steroid withdrawal. Conclusions: Chronic relapsing inflammatory optic neuropathy requires careful consideration and differentiation from demyelinating optic neuritis and ischemic optic neuropathy since the treatment is different and the outcome without treatment is likely to be poor. The importance of identifying these patients has considerable clinical implications as the condition is highly responsive to steroids. Introduction Chronic relapsing inflammatory optic neuropathy (CRION) is a recently described form of recurrent iso- lated optic neuropathy. The condition comprises a char- acteristic clinical syndrome of subacute optic neuropathy with prominent pain in which there is a clear and prompt response to treatment with systemic steroids but a relapse on steroid withdrawal [1]. The condition does not exhibit any evidence of additional neurological deficits, sarcoidosis or systemic autoim- mune diseases. Kidd et al. in their report of 15 patients described a clinical syndrome of unilateral or bilateral optic neuropathy characterized by pain followed by sub- acute visual loss in keeping with an inflammatory cause [1]. Treatment with corticosteroids induced abrupt relief of pain and restoration of visual acuity. Following ster- oid withdrawal patients tended to relapse, warranting in most cases long term immunosuppression. * Correspondence: asamra@nhs.net Department of neurology, South Devon Healthcare NHS Foundation Trust, TQ2 7AA, UK Case presentation A 52-year-old Caucasian woman with a past medical history of severe hypertension and non-insulin depen- dent diabetes mellitus presented with bilateral subacute visual loss which progressed over eight to 10 days to perceiving only light in the left eye and only hand move- ments in the right eye. The visual loss was preceded by dull ocular pain which persisted after the onset of visual loss. The patient experienced pain on eye movements but had no double vision. The patient did not have any temporal artery tenderness and temporal pulses were palpable bilaterally. On fundoscopic examination, both optic discs were swollen and no retinopathic changes of diabetes or hypertension were evident. There was no evidence of venous engorgement. There was reduced color vision in both eyes and a left relative afferent papillary defect was present. Visual field mapping showed a left central sco- toma and a normal right sided visual field. The patient’s blood pressure was 152/80 on admission and lower on subsequent readings during her hospital stay. The remaining neurological examination was unremarkable. There was nothing in her history or physical © 2012 Samra and Ramtahal; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.