Atypical presentation of optic neuritis with unilateral inferior altitudinal visual field defect in multiple sclerosis
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Abstract
Background: The purpose of this paper was to report a case of retrobulbar optic neuritis as the first manifestation of multiple sclerosis, with atypical presentations which include a sudden painless reduction in vision, without optic disc swelling and presence of unilateral inferior altitudinal visual field defect.
Case report: A 17-year-old girl presented to our clinic with right eye sudden painless drop in visual acuity to counting finger associated with headache. Her right eye optic nerve function tests were positive, but her optic disc was not swollen. Bjerrum’s visual field chart noted right eye unilateral inferior altitudinal visual field defect with foveal involvement. Her blood investigations were normal, and magnetic resonance imaging (MRI) of brain and orbit was suggestive of multiple sclerosis. She was commenced on three days of high dose intravenous steroi, and was referred to neuromedical team for further management. At 3-month follow up, her right eye visual acuity improved to 6/6 with the restoration of normal colour vision.
Conclusions: In presence of atypical presentation of optic neuritis, multiple sclerosis must be thought of especially in young patients. Hence early co-management with neuromedical discipline is important to reduce the frequency and severity of attacks in the future.
Keywords: retrobulbar optic neuritisinferior altitudinal defectmultiple sclerosisvisual field
References
- Gaier ED, Boudreault K, Rizzo JF, et al. Atypical Optic Neuritis. Curr Neurol Neurosci Rep. 2015; 15(12): 76.
- Kale N. Optic neuritis as an early sign of multiple sclerosis. Eye Brain. 2016; 8: 195–202.
- Pau D, Al Zubidi Nu, Yalamanchili S, et al. Optic neuritis. Eye. 2011; 25(7): 833–842.
- Wilhelm H, Schabet M. The Diagnosis and Treatment of Optic Neuritis. Dtsch Arztebl Int. 2015; 112(37): 616–25; quiz 626.
- Keltner JL, Johnson CA, Cello KE, et al. Optic Neuritis Study Group. Visual field profile of optic neuritis: a final follow-up report from the optic neuritis treatment trial from baseline through 15 years. Arch Ophthalmol. 2010; 128(3): 330–337.
- Trapp BD, Peterson J, Ransohoff RM, et al. Axonal transection in the lesions of multiple sclerosis. N Engl J Med. 1998; 338(5): 278–285.
- Hoorbakht H, Bagherkashi F. Optic neuritis, its differential diagnosis and management. Open Ophthalmol J. 2012; 6: 65–72.
- Optic Neuritis Study Group. Multiple sclerosis risk after optic neuritis: final optic neuritis treatment trial follow-up. Arch Neurol. 2008; 65(6): 727–732.
- Hayreh SS. Pathogenesis of visual field defects. Role of the ciliary circulation. Br J Ophthalmol. 1970; 54(5): 289–311.
- Kupersmith MJ, Alban T, Zeiffer B, et al. Contrast-enhanced MRI in acute optic neuritis: relationship to visual performance. Brain. 2002; 125(Pt 4): 812–822.