Mimics of Optic Neuritis in Neuromyelitis Optica Spectrum Disorder: A Case Report

Abstract

The optic nerve can be involved in a myriad of pathologies underscoring the importance of ruling out both surgical as well as medical causes. Often, it is the temporal profile, clinical presentation and imaging that helps to establish the final diagnosis. Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory demyelinating disorder involving the optic nerves and the spinal cord, which if promptly and adequately managed, may yield gratifying outcomes. We report an unusual presentation of NMOSD, mimicking a compressive optic neuropathy. A comprehensive review of the history, extensive investigations including brain and spinal cord imaging, and positive anti-aquaporin 4 antibodies helped in the definitive management.

Keywords: Neuromyelitis optica; optic nerve; radiation-induced optic neuropathy; tuberculum sellae meningioma.

Figure 1.

(a) Gadolinium-enhanced magnetic resonance imaging (Gd-MRI) of the brain showing a tuberculum sellae meningioma (arrowed), just anterior to the optic chiasm, abutting the right optic nerve. Follow-up Gd-MRI four years (b) and five years and 10 months later (c) showing residual sellae meningioma (arrowed) with no signs of optic nerve compression

Figure 2.

Fundus photographs showing bilateral secondary optic atrophy with optic disc pallor; (a) – right and (b) – left