Localised chiasmal optic neuritis in neuromyelitis optica spectrum disorder

• Published in: Practical neurology Vol. 22; no. 2; pp. 154 - 155
• Main Authors: Tsunogae, Marie, Yoshimura, Hajime, Matsuzaki, Mitsuhiro, Yokota, Satoshi, Kawamoto, Michi
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 01.04.2022; BMJ Publishing Group LTD
• Subjects: Aquaporin 4; Humans; Image of the moment; Immunoglobulins; Immunotherapy; Lymphoma; MRI; neuroimmunology; Neurology; Neuromyelitis Optica - complications; Neuromyelitis Optica - diagnostic imaging; ophthalmology; Optic nerve; Optic Neuritis - complications; Sarcoidosis; MRI; neuroimmunology; ophthalmology
• DOI: 10.1136/practneurol-2021-003120
• ISSN: 1474-7758

MR scan of orbit showed enhanced optic chiasm enlargement with slight extension to the right posterior optic nerve, suggesting a neoplasm or inflammatory process such as sarcoidosis (figure 2A–C).2–4 Her cerebrospinal fluid (CSF) was clear with normal pressure, containing 6 cells/µL (≤5), protein 1.2 g/L (0.15–0.45) and glucose of 2.7 mmol/L. Previous studies have reported that the disorder tends to affect the posterior parts of the optic nerves, including the chiasm, while patients with multiple sclerosis or anti-myelin oligodendrocyte glycoprotein antibody positivity tend to have unilateral or bilateral anterior optic nerve involvement.6 However, a localised chiasmal lesion, causing bitemporal hemianopia, is rare in neuromyelitis optica spectrum disorder, requiring prompt and careful differentiation from other diseases such as sarcoidosis, and neoplasms including glioma, lymphoma and metastatic tumours.2–4 Since early immunotherapy can lead to good visual prognosis, clinicians should keep in mind that neuromyelitis optica spectrum disorder can manifest with a localised chiasmal lesion. Ethics statements Patient consent for publication Consent obtained directly from patient(s) Contributors All authors contributed to data collection, analysis, drafting, and review of this manuscript.