J Korean Ophthalmol Soc.  2014 Nov;55(11):1721-1725. 10.3341/jkos.2014.55.11.1721.

Optic Neuritis Mimicking Ischemic Optic Neuropathy and Optic Glioma

• Kang EM
• Kwon KY
• Choi MJ
• Kim CY
• Seong GJ
• Hong S

• KMID: 2216625
• DOI: http://doi.org/10.3341/jkos.2014.55.11.1721

Abstract

PURPOSE
To report a case of optic neuritis difficult to differentiate from ischemic optic neuropathy and optic nerve glioma.
CASE SUMMARY
A 63-year-old male visited our clinic because of a sudden painless decrease in visual acuity in his right eye. He had a relative afferent pupillary defect and inferior altitudinal scotoma with disc pallor in his right eye. Ischemic optic neuropathy was suspected based on these clinical observations. However, a focal enhancing lesion was found in the intracranial portion of the right optic nerve on gadolinium-enhanced T1-weighted MRI. The radiologist's report revealed right intracranial optic glioma. Optic neurectomy was planned in accordance with the suspicion for optic glioma. However, a systemic mega-dose methylprednisolone therapy which is relatively less invasive was performed first based on the decision that optic neuritis should be distinguished from optic nerve glioma. The patient was hospitalized and 1 gram of methylprednisolone was injected intravenously daily for 3 days. The patient's visual acuity in the right eye improved from 0.1 before treatment to 0.3 after treatment. MRI scans at 8 months after steroid treatment showed disappearance of the previously enhanced lesion suspicious for optic glioma with developed atrophic change. The patient was finally diagnosed with optic neuritis based on these results.
CONCLUSIONS
Careful differential diagnoses and therapeutic approaches to possible diseases are necessary because optic neuritis can manifest as a variety of clinical entities and imaging findings.

Keyword

Ischemic optic neuropathy; Optic nerve glioma; Optic neuritis

MeSH Terms

Diagnosis, Differential
Humans
Magnetic Resonance Imaging
Male
Methylprednisolone
Middle Aged
Optic Nerve
Optic Nerve Glioma*
Optic Neuritis*
Optic Neuropathy, Ischemic*
Pallor
Pupil Disorders
Scotoma
Visual Acuity
Methylprednisolone

Figure

• 

  Figure 1. Change of visual field before and after steroid treatment. (A) Visual field of right eye showing inferior altitudinal scotoma at first visit. (B) The scotoma on right eye improved at 20 months after steroid therapy. POS = positive; NEG = negative; ASB = apostilbs, the unit of luminance; Rx = refractive error; DS = diopter sphere; DC = diopter cylinder; GHT = glaucoma hemifield test; VFI = visual field index; MD = mean deviation; PSD = pattern standard deviation.

• 

  Figure 2. Gadolinium-enhanced T1-weighted MRI on initial presentation: showing focal enhancement and enlargement (white arrow) of the intracranial portion of the right optic nerve at coronal view (A) and axial view (B).

• 

  Figure 3. Gadolinium-enhanced T1-weighted MRI in 8 months after steroid treatment. Enhanced lesion which optic glioma was suspected was lost and atrophic change (white arrow) was observed at coronal view (A) and axial view (B).

Reference

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