Clinico-Pathological Quiz

Abstract

A 7 years old Thai boy in Chonburi province. He had blurred vision for 2 weeks.

He had no eye pain and diplopia.

The physical examination present as follow:

V/S BT 36.6c, PR 103/min, RR 20/min, BP 103/65 mmHg

Alert, E4V5M6, no dysarthria, no aphasia, motor power gr. V

Sensory intact, stiffness of neck negative, Babinski sign plantar flexion,

Clonus negative, Deep tendon reflex right 3+, left 2+

Right eye: hand movement, positive relative afferent pupillary defect (RAPD)

Left eye: at least finger count

Imaging: Magnetic Resonance Imaging (MRI) show as the following:

The histological study show as the following: