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TitelChiasmal optic neuritis: an unusual presentation of neuromyelitis optica
DoelNeuromyelitis optica (NMO) is a rare auto-immune disease affecting the visual pathways and the spinal cord. Its diagnosis can be very challenging, particularly if seronegative. The visual loss features usually mimic the typical optic neuritis but may be unusual depending on the localization of the inflammation.
MethodesCase Report
ResultatenWe report a case of a 31-year-old African girl who was followed in neurology for a history of recurrent myelitis. Despite negative AQP4 and MOG antibodies, the diagnosis of NMO was retained based on a typical dorsal brainstem lesion at MRI. A few years later and despite immunosuppressive treatment, the patient presented with sudden bilateral visual loss associated with intensive glare and constant photopsia. She didn’t experience any retrobulbar pain nor dyschromatopsia. Visual field showed a large central and paracentral bitemporal scotoma. Fundus was normal. The MRI revealed a FLAIR hyperintensity and T1 contrast enhancement of the optic chiasma. Methylprednisolone intravenously (1g/day for 5 days) showed a poor response. Plasmapheresis allowed a drastic improvement.
ConclusieIsolated chiasma involvement in NMO is exceptional. Early recognition of clinical features allows a prompt treatment with a good visual improvement.
BelangenverstrengelingNee
Auteur 1
NaamCOCHE
InitialenA
InstituutUCL
StadWoluwe-Saint-Lambert
Auteur 2
NaamVAN PESCH
InitialenV
InstituutUCL
StadWoluwe-Saint-Lambert
Auteur 3
NaamDUPREZ
InitialenT
InstituutUCL
StadWoluwe-Saint-Lambert
Auteur 4
NaamBOSCHI
InitialenA
InstituutUCL
StadWoluwe-Saint-Lambert
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