Optic perineuritis: a further cause of visual loss and disc edema in children

The crucial role of gadolinium-enhanced MRI in a case of amaurosis fugax - a case report and literature review

Optic perineuritis is the inflammation of the optic nerve sheath. This affliction can lead to visual field impairment and other signs and symptoms related to the orbital space, such as pain, disc edema, ophthalmoplegia, proptosis. However, not all patients present with such suggestive symptoms, requiring a thorough assessment. We report the case of a young male admitted to our hospital for recurrent episodes of monocular blindness. Amaurosis fugax is a well-known presentation of transient ischemic attacks (TIA) and it was ruled out. Gadolinium-enhanced MRI revealed a typical aspect of optic perineuritis. It was mandatory to consider all possible causes of secondary optic perineuritis as they all represent serious clinical conditions, even if the idiopathic form is more frequent. The clinical and paraclinical evaluation of the patient excluded an underlying disease and primary optic perineuritis was diagnosed. Corticosteroid therapy is usually curative and a course of methylprednisolone was initiated for our patient with good outcome. However, response to treatment is not diagnostic as both primary and secondary optic perineuritis are normally responsive, hence thorough differential diagnosis is necessary.

Caecocentral Scotoma: A Rare Presentation of Optic Perineuritis

Optic perineuritis (OPN) is a subtype of optic neuritis (ON) in which the inflammatory process involves meningeal sheath surrounding the optic nerve. Clinically, OPN simulates ON. However, in contrast to ON, patient with OPN shows sparing of central vision, improves dramatically with high-dose corticosteroid, are more likely to experience recurrence after stopping treatment. We report a rare case of caecocentral scotoma observed in a female with typical ON symptoms. Her magnetic resonance imaging showed features in line with OPN. She was treated with intravenous methylprednisolone 1 g/day for five days followed by slow tapering dose of oral prednisolone for one month. Her vision improved dramatically with a resolution of visual field defect. No relapses seen within two years of follow-up.

Usefulness of B-scan ocular ultrasound images for diagnosis of optic perineuritis

Purpose

This study was performed to examine the usefulness of B-scan ocular ultrasound images for the diagnosis of optic perineuritis.

Observations

A 72-year-old woman developed nonpainful blurred vision in her left eye. At the first ophthalmological consultation, she had optic disc swelling and choroidal folds in both eyes and subretinal fluid in the left eye. She was referred to our clinic 1 month after symptom onset. At the first visit to our clinic, she still complained of blurred vision. She was found to have mild vitreous cells in the left eye and optic disc swelling in both eyes. However, the choroidal folds had already resolved in both eyes. B-scan ultrasound images displayed the optic nerve sheath as a highly reflective circle with shadowing around the optic disc in both eyes and scleral thickening in the left eye with fluid in sub-Tenon's space. Bilateral optic perineuritis with posterior scleritis seemed highly plausible. Magnetic resonance imaging with intravenous contrast revealed increased signal intensity around the optic nerve (i.e., the “tram track sign”) in both eyes, which was consistent with optic perineuritis.

Conclusion and importance

Optic perineuritis is a rare inflammatory disorder involving the optic nerve sheath. Although magnetic resonance imaging is reportedly useful for diagnosis of this disease, no previous reports have described B-scan ultrasound imaging for this purpose. We herein provide the first report of a patient suspected to have optic perineuritis based on B-scan images. B-scan ultrasound may be useful for diagnosis of optic perineuritis, especially with inflammation surrounding the optic nerve.

A unilateral optic perineuritis in a teenager - A case report

Optic perineuritis is an uncommon inflammatory disorder that involves optic nerve sheath. Numerous case reports have been published on optic perineuritis in adults, the majority of whom had bilateral presentation. There are limited data on optic perineuritis occurring in pediatric patients. We report a teenager who presented with a unilateral sign that mimicked the presentation of optic neuritis. The orbit and brain magnetic resonance imaging confirmed features of unilateral optic perineuritis. She was treated with a high dose of corticosteroids for 2weeks, and her final visual outcome was satisfactory. No signs of relapse were noted during follow-up visits.