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A 12-year-old girl with a history of bilateral optic nerve enlargement, enterovirus meningitis, seizures, and bilateral hygromas, presented with acute onset chronic vision loss in her left eye. Two years prior, she presented to an outside hospital with headaches, intermittent speech arrest and right-sided weakness, and was diagnosed with enterovirus meningitis and seizures. Incidentally, she was noted to have bilateral optic nerve enlargement. She had no visual symptoms until four months prior to presentation when she was again admitted with headaches and transient neurologic deficits. Neuroimaging was notable for new bilateral hygromas, further enlargement of the optic nerves, and septations of the subarachnoid space thought to be related to prior meningitis. Lumbar puncture was unremarkable, and PET scan revealed a paraspinal mass near the left L4-L5 nerve root. Biopsy was consistent with neuroblastic tumor, thought to be isolated, and managed with partial resection. Additionally, extensive dural ectasia of the spine was observed. An attempt to drain the hygromas revealed high CSF output that required subgaleal-peritoneal shunt placement, later removed due to infection. During her admission, she reported blurred vision. Initial ophthalmological evaluation revealed subnormal acuities in the left more than right eye and dyschromatopsia in both eyes, with normal pupils and optic discs. The etiology of vision loss was postulated to be optic neuropathy secondary to high intracranial pressure from her hygromas. After discharge she remained stable for another three months until she noted complete vision loss in her left eye and was referred to our facility for neuro-ophthalmological consultation. Her examination was significant for visual acuity of 20/60 in the right eye and light perception in the left eye, a left afferent pupillary defect, and bilateral optic disc temporal pallor with nasal edema in the right eye. There were no Lisch nodules