Optic Neuritis Associated with SARS-CoV-2 B.1.1.7 Variant of Concern

• Published in: Canadian Journal of Neurological Sciences Vol. 49; no. 4; pp. 591 - 592
• Main Authors: Micieli, Jonathan A., Yu, Caberry W.
• Format: Journal Article
• Language: English
• Published: New York, USA Cambridge University Press 01.07.2022
• Subjects: Edema; Magnetic resonance imaging; Multiple sclerosis; Neuroimaging Highlight; Optic nerve; Severe acute respiratory syndrome coronavirus 2; Visual acuity; COVID-19; Vision loss; SARS-CoV-2; Optic neuritis
• ISSN: 0317-1671; 2057-0155
• DOI: 10.1017/cjn.2021.183

Magnetic resonance imaging (MRI) of the brain/orbits with contrast showed increase T2-weighted signal intensity, enlargement, and enhancement of the intraorbital/intracanalicular segments of the right optic nerve and sheath (Figure 1B and C). Magnetic resonance imaging (MRI) of the orbits demonstrating increased T2 signal in the right optic nerve (B), enhancement of the right optic nerve and optic nerve sheath (C), and FLAIR MRI showing signal intensity along the lateral margin of the pons without enhancement (D). Since its first reported case in December 2019, SARS-CoV-2 has been linked with a broad range of ocular manifestations.1 This is a rare case of optic neuritis associated with a SARS-CoV-2 variant of concern (alpha), which became prevalent in Ontario, Canada at the time of this patient’s presentation. SARS-CoV-2 is hypothesized to be a neurotropic virus that enters the cell through ACE2 receptors, which are expressed in the brain and retina.5 SARS-CoV-2 has been previously associated with central nervous system involvement, including in exacerbations of multiple sclerosis, and to MOG-IgG and AQP4-IgG-positive optic neuritis.3 While our patient presented with typical features of optic neuritis, additional workup did not reveal serological evidence of neuromyelitis optica spectrum disorder, MOG-IgG, or brain lesions diagnostic of multiple sclerosis. [...]the optic neuritis in this patient may represent a separate parainfectious process caused by the viral illness, either through direct viral injury or an unrecognized autoantibody response.