Bilateral Optic Perineuritis as Initial Presentation of Giant Cell Arteritis

Area of Science:

• Neurology
• Ophthalmology
• Vascular Inflammation

Background:

• Giant cell arteritis (GCA) is a systemic vasculitis affecting large arteries.
• Neurological complications, including visual disturbances and stroke, are known manifestations of GCA.
• Anterior ischemic optic neuropathy is the most common cause of visual impairment in GCA.

Observation:

• A patient presented with a peripheral monocular visual field defect.
• This visual defect was the primary presenting ocular feature of the disease.
• The underlying cause was identified as optic perineuritis.

Findings:

• Optic perineuritis, inflammation of the optic nerve sheath, was the cause of the visual field defect.
• This presentation is atypical for Giant Cell Arteritis.
• The case underscores the diverse neurological and ocular manifestations of GCA.

Implications:

• Optic perineuritis should be considered in the differential diagnosis of visual field defects, even in the absence of typical GCA symptoms.
• Early recognition and treatment of GCA are crucial to prevent irreversible vision loss.
• This case expands the understanding of ocular presentations in large vessel vasculitis.