In recent issues of the Archives of Ophthalmology and the Archives of Neurology, Kennerdell et al1 and Hackett et al,2 respectively, have reported cases in which what appeared initially to be optic neuritis was the premonitory symptom of a serious underlying disease.
The patient described by Kennerdell and his colleagues was a 47-year-old woman who first complained of blurred vision in the right eye accompanied by pain on motion of the globe and deep retro-orbital discomfort. Her visual acuity in the affected eye was best corrected to 20/400, and the optic disc was hyperemic. Based on a presumptive diagnosis of optic neuritis, corticosteroid therapy was administered and led to dramatic visual improvement. Relapse followed within a month, but resumption of corticosteroid therapy again was effective.
About a year later, visual acuity was again impaired, now bilaterally, and there was deep suborbital pain on the right. Skull roentgenograms and