Diffuse multiple sclerosis and chronic central serous chorioretinopathy: pitfall not to ignore

High-dose intravenous corticosteroids are effective in treating acute optic neuritis.1 However, certain ophthalmological conditions should be considered before treatment as they can be worsened by corticosteroids: this emphasises the need for collaboration between neurologists and neuro-ophthalmologists.2 ,3 A 47-year-old man presented in 1999 with right-sided optic neuritis. This was treated with intravenous corticosteroids and he made a good recovery, with post-treatment visual acuity of 6/6. Between 1999 and 2004, he had several episodes of sensory symptoms, not requiring treatment. Imaging corroborated the clinical diagnosis of multiple sclerosis4 and he was treated with weekly interferon s1a (Avonex) 30 µg. In 2005, he presented with a left optic neuritis, treated by high dose corticosteroids and again with good ophthalmological recovery. Unfortunately, in 2006, he began to develop a progressive paraplegia. He then presented with bilateral impairment of vision, with decreased visual acuity to 6/19 (right) and 6/9.5 (left). He did not undergo dilated fundus examination. He also reported worsening of the motor symptoms and sphincter disturbance. Intravenous high-dose corticosteroids treatment was started and, despite the treatment, he reported a painless decrease of visual acuity in the right eye, with a scotoma resembling a …