Optic neuritis or ophthalmic artery aneurysm? Case presentation with histopathologic documentation utilizing a new...

Area of Science:

• Neuroscience
• Ophthalmology
• Pathology

Background:

• Optic neuritis is a common diagnosis for sudden vision loss.
• Noninvasive studies can be inconclusive in diagnosing the cause of optic nerve damage.

Observation:

• An elderly woman presented with progressive vision loss, initially diagnosed as optic neuritis.
• Despite prednisone treatment, vision loss continued.
• Autopsy revealed an ophthalmic artery aneurysm compressing the optic nerve.

Findings:

• Histological examination using a novel staining technique identified degenerated axons.
• Degeneration was traced from the optic nerve compression site to five primary visual nuclei.
• Transsynaptic cellular changes were observed in the lateral geniculate nucleus.

Implications:

• Ophthalmic artery aneurysms can cause optic nerve compression and subsequent visual pathway degeneration.
• Novel staining techniques are valuable for diagnosing long-term axonal damage.
• This case highlights the importance of considering vascular causes in optic neuropathy.