PMC4000303_01
MRI findings in the brain. a FLAIR image at day 1 showing abnormal signals in both lateral geniculate bodies, indicated by arrows. The left frontal lesion is an old traumatic lesion. b FLAIR image at day 20 showing high-intensity lesions in both lateral geniculate bodies, the size of which is reduced compared to a. c The lateral geniculate bodies and the posterior end of the optic tracts (d) were bilaterally enhanced with gadolinium, but the optic nerves (e) and optic chiasm (f) were not.
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F1
A few days later, the patient visited a neurosurgery hospital where MRI revealed abnormal signals in both lateral geniculate bodies (fig. 1a). T2-weighted MRI and FLAIR images showed high-intensity lesions in both lateral geniculate bodies (fig. 1b); however, the size of these lesions was reduced compared with that of previously observed lesions. The posterior end of the optic tracts and lateral geniculate bodies were bilaterally enhanced with gadolinium, but the optic nerves and optic chiasm were not (fig. 1c-f).
Ophthalmologic findings. a Goldman visual field examination showing bilateral incomplete homonymous hemianopia. b Visual field defects were relieved 2 weeks after treatment. c Optical coherence tomography showing a macular edema on the left retina. d Fluorescein fundus angiography in both eyes showing characteristic fernlike fluoro-leak images. Rt = Right side, Lt = left side.
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F2
Goldman visual field examination showed bilateral incomplete homonymous hemianopia (fig. 2a). Optical coherence tomography showed a macular edema on the left retina (fig. 2c), and fluorescein fundus angiography in both eyes revealed a fernlike fluoro-leak image (fig. 2d), both of which indicated posterior uveitis. MRI images taken 2 weeks after treatment onset, and the visual field defects had improved (fig. 2b). Methotrexate was added from day 50 at a dose of 6 mg/week and was increased to 8 mg/week on day 70, while the dose of PSL was decreased gradually to 18 mg/day.