Topic outline

  • Grand Rounds

    A patient presented to the emergency room with acute vision loss in the left eye for two weeks. Examination revealed 20/400 vision, crowded nerve with blurred margin, and afferent pupillary defect in the left eye. MRI orbit with and without contrast revealed subtle enhancement of anterior, intraconal portion of the optic nerve and scattered FLAIR hyperintensities in paraventricular white matter. The patient was started on intravenous steroid therapy for presumed acute optic neuritis, followed by oral prednisone taper. Diagnostic laboratory testing was positive for an elevated level of serum Aquaporin-4 antibody. Further investigation revealed a non-active lesion in the cervical spinal cord. The diagnosis of NMO spectrum disorder was made and the patient was started on disease-modifying therapy. His vision was recovered to 20/20 with a normal visual field. His clinical course and ophthalmic findings are documented photographically in this presentation. This case highlights NMO spectrum disorder can mimic ischemic optic neuropathies and the differential diagnosis should be considered in appropriate clinical setting.

    Presentation Date: 01/07/2021
    Issue Date: 07/23/2021