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Title

Chiasmal optic neuritis: an unusual presentation of neuromyelitis optica

Purpose	Neuromyelitis 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.
Methods	Case Report
Results	We 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.
Conclusion	Isolated chiasma involvement in NMO is exceptional. Early recognition of clinical features allows a prompt treatment with a good visual improvement.
Conflict of interest	No

Authors 1

Last name	COCHE
Initials	A
Department	UCL
City	Woluwe-Saint-Lambert

Authors 2

Last name	VAN PESCH
Initials	V
Department	UCL
City	Woluwe-Saint-Lambert

Authors 3

Last name	DUPREZ
Initials	T
Department	UCL
City	Woluwe-Saint-Lambert

Authors 4

Last name	BOSCHI
Initials	A
Department	UCL
City	Woluwe-Saint-Lambert