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Bilateral optic nerve sheath enhancement from giant cell arteritis
Kenneth E Morgenstern1, Brian D Ellis, Sidney S Schochet
1Department of Ophthalmology and Neuropathology, West Virginia University Hospitals, Morgantown, West Virginia 26506, USA. Kmorgenstern@hsc.wvu.edu
The Journal of Rheumatology
|March 1, 2003
Summary
Giant cell arteritis can cause acute vision loss by affecting optic nerve sheaths, as indicated by MRI enhancement. Biopsies confirmed inflammation, suggesting this imaging finding is a manifestation of the systemic disease.
Area of Science:
- Ophthalmology
- Neurology
- Rheumatology
Background:
- Giant cell arteritis (GCA) is a systemic vasculitis affecting large and medium-sized arteries.
- Ocular involvement in GCA can lead to irreversible vision loss.
Observation:
- An 83-year-old male presented with sudden bilateral vision loss and optic disc edema.
- MRI revealed enhancement of optic nerve sheaths and orbital fat.
- Elevated sedimentation rate (60 mm/h) was noted.
Findings:
- Histopathology of optic nerve sheath biopsies showed fibroadipose tissue with inflamed arteries.
- Temporal artery biopsies revealed inflammation and elastic lamina disruption consistent with GCA.
- Vision stabilized with intravenous methylprednisolone therapy.
Implications:
- Optic nerve sheath enhancement on MRI may indicate GCA in patients with visual symptoms.
- This finding suggests a shared pathophysiology between optic nerve sheath changes and GCA.
- Early diagnosis and treatment of GCA are crucial to prevent vision loss.