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Case Reports
. 2015 Aug 3:2015:bcr2015210259.
doi: 10.1136/bcr-2015-210259.

Masquerading optic neuritis

Katherine McVeigh  1 , Georgios Vakros  2 , Rafik Girgis  1
Affiliations
Case Reports

Masquerading optic neuritis

Katherine McVeigh et al. BMJ Case Rep. .

Abstract

A 54-year-old woman presented to the ophthalmology emergency department with a 10-day history of blurred vision. The best-corrected visual acuities and Ishihara colour vision were bilaterally reduced with a left relative afferent pupillary defect. Slit-lamp examination was otherwise normal. Retrobulbar optic neuritis (ON) was presumed as she had suffered with this previously and was known to have multiple sclerosis (MS). She was recalled the following week for visual field (VF) testing, which was not available at the time of presentation. VFs demonstrated an incongruous left homonymous hemianopia. She was immediately referred to the medical team to investigate for a stroke, which was subsequently excluded. Thereafter, a trial of pulsed methylprednisolone was commenced, resulting in near complete resolution of the hemianopia. This case demonstrates not only the importance of VF testing, but also how ON may present with any field defect, including mimicking a stroke, a point valuable to ophthalmologists and medics alike.

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Figures

Figure 1
Figure 1
Humphrey Visual Fields 30-2: Left homonymous hemianopia, pre-treatment.
Figure 1
Figure 1
Continued.
Figure 2
Figure 2
MRI scan showing lesions over right thalamus (A) and left periventricular matter (B).
Figure 3
Figure 3
Humphrey Visual Fields 30-2: Resolution of homonymous hemianopia, post-treatment.
Figure 3
Figure 3
Continued.
See this image and copyright information in PMC

References

    1. Pau D, Zubidi N, Yalamanchili S et al. . Optic neuritis: review. Eye 2011; 25:833–42. 10.1038/eye.2011.81 - DOI - PMC - PubMed
    1. Keltner J, Johnson C, Cello K et al. . 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;128:330–7. 10.1001/archophthalmol.2010.16 - DOI - PMC - PubMed
    1. Hawkins K, Behrens M. Homonymous hemianopia in multiple sclerosis. With report of bilateral case. Br J Ophthalmol 1975;59:334–7. 10.1136/bjo.59.6.334 - DOI - PMC - PubMed
    1. Plant GT, Kermode AG, Turano G et al. . Symptomatic retrochiasmal lesions in multiple sclerosis: clinical features, visual evoked potentials, and magnetic resonance imaging. Neurology 1992;42:68–76. 10.1212/WNL.42.1.68 - DOI - PubMed
    1. Gunderson CH, Hoyt WF. Geniculate hemianopia: incongruous homonymous field defects in two patients with partial lesions of the lateral geniculate nucleus. J Neurol Neurosurg Psychiatry 1971;34:1–6. 10.1136/jnnp.34.1.1 - DOI - PMC - PubMed

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