Optic neuritis

Case contributed by Dr Hoe Han Guan

Presentation

Recurrent blurred vision of the left eye with intermittent headache.

Patient Data

Age: 30 years
Gender: Female

Brain

mri

No abnormal signal intensity in the brain parenchyma or focal brain parenchymal lesion.
No midline shift.  No hydrocephalus.
Ventricles and cerebral sulci are normal. Basal cisterns are not effaced.
No restricted diffusion on DWI/ADC.
No blooming artefact on GRE to suggest blood product or calcification.
Midline structures, brainstem and cerebellum are normal.

Orbit

mri

Swelling of the retrobulbar intra-orbital segment of the left optic nerve, extending to the intracranial segment without involvement of optic chiasm. The swollen left optic nerve has signal intensity on T2WI well-visualized on coronal T2 fat suppressed sequence and shows enhancement on postcontrast T1 fat suppressed sequence.
Indistinct margin of the intra-orbital segment of left optic nerve to the surrounding subarachnoid space within the optic sheath.


The right optic nerve is normal in size. No abnormal signal intensity or enhancement. 

Whole spine

mri

The spinal alignment is normal. 
The cervicomedullary junction is normal. No abnormal signal intensity or intramedullary lesion in the spinal cord on sagittal T1WI and T2WI.
Conus medullaris lies at L1 level. 
Normal vertebral body heights and marrow signal intensity. 
The intervertebral disc thickness and signal intensity are preserved.

Case Discussion

MR features are consistent with isolated left optic neuritis. No MR evidence of demyelinating changes in the brain and spinal cord.

MRI is the best imaging modality for diagnosis of optic neuritis , where the affected optic nerve will appear as unilateral optic nerve swelling, high signal intensity on T2 weighted imaging and shows variable contrast enhancement.

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