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JAMA Ophthalmology Clinical Challenge
November 18, 2021

An Atypical Case of Optic Neuropathy

Author Affiliations
  • 1Department of Ophthalmology, Baylor College of Medicine/Cullen Eye Institute, Houston, Texas
  • 2Section of Ophthalmology, Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas
JAMA Ophthalmol. 2022;140(1):88-89. doi:10.1001/jamaophthalmol.2021.1466

A 17-year-old previously healthy girl presented with 3 months of decreased vision in the right eye associated with throbbing pain with eye movement. The patient had no history of weakness, incontinence, or severe headaches. Initial presentation was notable for hand motion visual acuity with a 2+ relative afferent pupillary defect on the right; fundus examination revealed grade IV disc edema with obscuration of all major vessels on the disc (Figure, A). A magnetic resonance image (MRI) of the brain with and without gadolinium contrast was degraded by motion and orthodontic artifact but was suggestive of optic nerve enhancement consistent with optic neuritis. Results of serology tests and cerebral spinal fluid analysis were negative for infectious and inflammatory etiologies, including syphilis, sarcoidosis, Lyme disease, viral etiologies, multiple sclerosis, and lupus.

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1 Comment for this article
Optic nerve glioma, MOGAD, and Pilocytic astrocytoma with anaplastic transformation.
Khichar Shubhakaran, M.D.(Med),D.M.(Neurology) | Dr S N Medical College, Jodhpur
Recently we came across one patient with unilateral visual impairment. On investigation, the diagnosis given by a radiologist was that of an optic nerve glioma associated with a swollen optic nerve. We reassessed the patient, and MOG antibodies were found to be positive. The patient is doing well on rituximab. This case may support the findings in the Clinical Challenge.