J Korean Ophthalmol Soc.  2021 Mar;62(3):419-424. 10.3341/jkos.2021.62.3.419.

Temporal Arteritis with Diagnostic Brain Magnetic Resonance Imaging

• Jang JH
• Kim ES
• Lee JY

• KMID: 2514260
• DOI: http://doi.org/10.3341/jkos.2021.62.3.419

Abstract

Purpose
To report a case of arteritic anterior ischemic optic neuropathy diagnosed with brain magnetic resonance imaging (MRI) for temporal arteritis instead of temporal artery biopsy.
Case summary
An eighty-three years old female visited our clinic for right blurred vision for 2 weeks ago with occipital headache for 4 months and mastication problems. Initial best corrected visual acuity was 0.1 in right eye. She had right inferior altitudinal visual field defect and superior pale optic disc swelling with few cotton wool spots were checked. In serologic tests, erythrocyte sedimentation rate, C reactive peptide, and rheumatoid factor were increased, and fluorescent antinuclear antibody was positive. We performed high resolution brain MRI which could find superficial temporal artery’s luminal signal. In MRI image, we could find loss of intraluminal signal intensity void with total luminal obstruction. We assumed as arteritic anterior ischemic optic neuropathy and high dose intravenous steroid was done. Visual acuity of right eye was 0.9 and central scotoma was improved 1 week after intravenous steroid. We changed to oral steroid with tapering and added oral azathioprine. After 11 months of oral steroid use, her visual acuity was 0.9 in right eye and inferior altitudinal visual field defect was much improved.
Conclusions
A patient suspected anterior ischemic optic neuropathy was diagnosed by brain MRI with abnormalities in superficial temporal artery. Visual acuity and visual field defect were improved by steroid and immunosuppressive treatment for arteritic anterior ischemic optic neuropathy.

Keyword

Arteritic anterior ischemic optic neuropathy, Brain magnetic resonance image, Giant cell arteritis, Temporal arteritis, Temporal artery biopsy