At this junction….

Area of Science:

• Neuro-ophthalmology
• Autoimmune Neurology

Background:

• Neuromyelitis optic spectrum disorder (NMOSD) is a rare autoimmune condition affecting the optic nerves and spinal cord.
• Optic neuritis is a common initial presentation of NMOSD, often leading to significant vision impairment.

Observation:

• An 81-year-old woman presented with acute, painful vision loss in her right eye.
• Ophthalmic examination revealed no acute pathology, but visual field testing indicated a superotemporal defect in the left eye.
• MRI revealed enhancement of the right optic nerve extending to the optic chiasm.

Findings:

• The patient's vision did not improve with intravenous corticosteroids.
• Significant visual recovery was achieved with therapeutic plasma exchange (TPE).
• Serological testing confirmed the presence of aquaporin-4 autoantibodies, establishing the diagnosis of NMOSD.

Implications:

• This case underscores the importance of considering NMOSD in elderly patients presenting with optic neuritis, even without typical spinal cord involvement.
• Therapeutic plasma exchange can be an effective treatment for vision-threatening NMOSD, particularly when corticosteroids fail.
• Early diagnosis and prompt initiation of appropriate treatment, such as TPE, are crucial for visual recovery in NMOSD.