PMC4218916_01
Orbital magnetic resonance imaging scans.. Notes: (A) Axial and (B) coronal views (postgadolinium T1 with fat saturation) on presentation, showing right optic nerve and nerve sheath enhancement. (C) Axial and (D) coronal views 3 weeks after presentation, showing right optic nerve and nerve sheath enhancement extending into the optic canal. (E) Axial and (F) coronal views 7 weeks after presentation, showing decreased right optic nerve and nerve sheath enhancement.
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Orbit MRI with contrast revealed enhancement of the right optic nerve and sheath (Figure 1A and B), as well as nonspecific periventricular, deep, and subcortical white matter lesions. Repeat MRI showed enhancement of the right optic nerve extending to the optic canal (Figure 1C and D). Seven weeks after the onset of symptoms, the vision in the right eye had improved to 20/400; repeat GVF showed expansion of the superior field (Figure 3B), eye pain resolved, and a repeat MRI found decreased right optic nerve enhancement (Figure 1E and F).
Fundus photos of both eyes.. Notes: (A) At 11 days after onset of symptoms, the right optic nerve head had diffuse edema, and (B) the left optic nerve head appeared normal. Three weeks after presentation, (C) the right optic nerve head showed persistent edema and (D) the left optic nerve remained normal.
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The right optic nerve head was diffusely edematous without hemorrhage (Figure 2A), and the left optic nerve head was normal with a 0.5 cup-to-disc ratio (Figure 2B). The right optic nerve head showed persistent edema and the left optic nerve remained normal (Figure 2C and D).
Goldmann visual field of the right eye.. Notes: (A) At 3 weeks after initial presentation, the right eye vision shows small islands in the superotemporal and superonasal fields. (B) At 7 weeks after initial presentation, the right eye shows severe visual field restriction, with small islands of vision remaining superiorly. (C) At 4 months after initial presentation, the right eye vision shows an inferior altitudinal defect.
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Goldmann visual field (GVF) showed severe constriction of the visual field, with a small superotemporal and superonasal island of vision remaining (Figure 3A). Seven weeks after the onset of symptoms, the vision in the right eye had improved to 20/400; repeat GVF showed expansion of the superior field (Figure 3B), eye pain resolved, and a repeat MRI found decreased right optic nerve enhancement (Figure 1E and F). GVF showed improved sensitivity in the superior field and a persistent inferior defect in the right eye (Figure 3C).