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Review
. 2018 Dec 12;18(1):317.
doi: 10.1186/s12886-018-0994-9.

Simultaneous bilateral posterior ischemic optic neuropathy secondary to giant cell arteritis: a case presentation and review of the literature

Anas Mohammad Albarrak  1 , Yousef Mohammad  2 , Sajjad Hussain  3 , Sufia Husain  4 , Taim Muayqil  5
Affiliations
Review

Simultaneous bilateral posterior ischemic optic neuropathy secondary to giant cell arteritis: a case presentation and review of the literature

Anas Mohammad Albarrak et al. BMC Ophthalmol. .

Abstract

Background: This report highlights a rare case of simultaneous bilateral blindness due to posterior ischemic optic neuropathy. Typically, ophthalmic involvement in giant cell arteritis is monocular or sequential ischemia of the anterior portion of the optic nerve, and less frequently simultaneous.

Case presentation: An 80-year-old Saudi male came with a history of simultaneous bilateral vision loss 5 days prior to presentation. The exam showed dilated non-reactive pupils, no light perception in both eyes, and normal fundus exam. C-reactive protein and erythrocyte sedimentation rate levels were high Magnetic resonance imaging and magnetic resonance angiography of the brain showed a right posterior optic nerve lesion and absence of flow in both ophthalmic arteries respectively. A left temporal artery biopsy confirmed giant cell arteritis.

Conclusion: The presentation of GCA can be atypical and patients may present with simultaneous blindness. Bilateral simultaneous PION does not exclusively occur in a post surgical setting, emphasizing the importance of decreasing the threshold of suspicion of similar cases to avoid further neurological complications.

Keywords: Blindness; Giant cell arteritis; Headache; Neuro-ophthalmology; Posterior ischemic optic neuropathy.

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Not applicable

Consent for publication

Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the consent form is available for review by the Editor of this journal.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
a Axial diffusion weighted images. b ADC maps, c high resolution T2 weighted images and d coronal T2 weighted images. Arrows showing true diffusion restriction in the right optic nerve with T2 signal hyperintensity
Fig. 2
Fig. 2
MRA of the patient (a) versus a normal individual (b) with arrows indicating severe narrowing in ophthalmic arteries in the patient bilaterally
Fig. 3
Fig. 3
Photomicrograph of a cross section of temporal artery shows (a) almost total occlusion of the vascular lumen (arrow) due to fibrointimal proliferation and arteritis (Hematoxylin and eosin stain; original magnification × 100.). b Infiltration of the arterial intima and media by patchy moderately dense lymphohistiocytic inflammatory cells (arrows). The arterial lumen is reduced to a narrow slit-like channel (arrowhead)(Hematoxylin and eosin stain; original magnification × 200.) c High magnification shows mononuclear inflammatory cell infiltrate mixed with scattered multinucleated giant cells (arrowhead) in the vessel wall. Fragmentation of the internal elastic lamina (arrow) and fibrointimal proliferation and edema (curved arrow) of the arterial intima is also shown (Hematoxylin and eosin stain; original magnification × 400.) d High magnification shows a lymphohistiocytic inflammatory cell infiltrate (arrowhead) destroying and disrupting the internal elastic lamina (arrow). (Hematoxylin and eosin stain; original magnification × 400.) Inset: shows elastic tissue stain highlighting the fragmented internal elastic lamina (arrowhead). (Elastic Van Gieson stain; original magnification × 400
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