Presentation
History of recent right papilloedema with decreased visual acuity.
Patient Data
Swelling of the intraorbital, intracanalicular and intracranial segments of the right optic nerve of a high T2 and T2 fat sat signal with enhancement on postcontrast sequences with moderate flattening of the posterior sclera as well as thickening with the enhancement of the optic nerve sheath and inflammatory changes of the intraconal fat.
Normal appearance of the left optic nerve and optic chiasma.
No demyelinating lesions seen at the infra or supratentorial level.
Case Discussion
The clinical presentation and the MRI features of unilateral swelling of high T2 signal with enhancement of the optic nerve are most consistent with optic neuritis with associated perineuritis (circumferential thickening with enhancement of the optic nerve sheath and inflammatory changes of the intraconal fat).