Optic neuritis with perineuritis

Case contributed by Ammar Haouimi
Diagnosis almost certain

Presentation

Three days history of left orbital pain with blurred vision.

Patient Data

Age: 30 years
Gender: Male

Swelling of the left optic nerve involving the retrobulbar intraorbital segment, extending to the intracranial segment with high T2 signal and enhancement in keeping with optic neuritis.

Circumferential thickening of the left optic nerve sheath with enhancement and inflammatory changes of the intraconal fat in keeping with a perineuritis.

Normal appearance of the right optic nerve and orbital muscles.

No demyelinating lesion seen at infra-or supratentorial levels.

Case Discussion

MRI features of a unilateral swelling with high T2 signal and enhancement of the left optic nerve indicating optic neuritis with associated perineuritis (circumferential thickening with enhancement of the optic nerve sheath and inflammatory changes of the intraconal fat).

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