Downbeat Nystagmus in a 7-Year-Old Girl with Epstein-Barr Virus-Associated Meningitis and Cerebellitis

Downbeat nystagmus is a type of jerk nystagmus that may be seen in patients with lesions affecting the vestibulocerebellum. This is a case of a 7-year-old girl presenting with a history of fever, headache, and episodic vertigo with downbeat nystagmus. The diagnosis of Epstein-Barr virus meningitis with acute cerebellitis was made by contrast magnetic resonance imaging, cerebrospinal fluid analysis, and serum Epstein-Barr virus titers. Contrast magnetic resonance imaging demonstrated enhancement of the meninges and inferior cerebellar folia, correlating with the neuroophthalmological symptom of downbeat nystagmus

Substantia Nigra Hyperintensities leads to diagnosis of Leber's Hereditary Optic Neuropathy

Leber's hereditary optic neuropathy (LHON) commonly presents with acute or subacute central vision loss mimicking optic neuritis. We describe a young man who presented with bilateral sequential optic neuropathy concerning for retrobulbar optic neuritis. His MRI head, however, revealed bilateral symmetric substantia nigra hyperintensities, unusual in a demyelinating disorder. This finding, along with positive family history, led to further work-up disclosing a diagnosis of LHON