Presentation
Sudden pain with deterioration of his vision.
Patient Data
Bilateral and circumferential thickening with enhancement of the optic nerve sheath with inflammatory changes of the intraconal fat. Normal appearance of the eye globes. Normal thickness and signal intensity of the optic chiasma, optic nerves and orbital muscles.
Old left occipital infarct in the posterior cerebral artery territory.
Case Discussion
MRI features of circumferential thickening with enhancement of the optic nerve sheath bilaterally with inflammatory changes of the intraconal fat, suggestive of optic nerve perineuritis, probably of idiopathic origin in this case.
Optic perineuritis is considered as a rare inflammatory process of the optic nerve sheath which may be primary (idiopathic) or secondary to systemic conditions (such as sarcoidosis, Crohn disease, syphilis, Behçet's disease, granulomatosis with polyangiitis, and systemic lupus erythematosus) 1,2.
The treatment includes a high dose of corticosteroids 1,2.