Arteritic bilateral anterior ischemic optical neuropathy: case report

Abstract

Introduction: Arteritic anterior ischemic optic neuropathy (AAION) is infarction in anterior segment of optic nerve in which there is thrombotic occlusion of short posterior ciliary arteries due to granulomatous inflammation of giant cell arteritis (ACG). Case report: Male patient, 66 years old, complaining of loss of vision in left eye (LE) for 28 days, and in right eye (RE) for 8 days, accompanied by left hemicranial headache, pulsatile, irradiation from frontal to cervical region, of strong intensity, prevalent at night. Report of pain on chewing, chills, night sweats, neck pain and headache for 2 months. On examination, there was no light perception and bilateral non-reactive pupils. At simple retinography, LE with pale optical disc (OD), attenuation of retinal vascularization, atrophic and whitish areas; RE with OD with undefined borders, peripapillary hemorrhages and areas of retinal pallor. At fluorescent retinography; LE without arterial filling; CBC, discrete anisocytosis, thrombocytosis and microcytosis; ESR, 71mm/h in first hour; CRP, 113.6 mg/L. At, doppler USG of temporal arteries, significant increase in thickness of the myointimal layer, causing hemodynamic repercussions, with monophasic flow. Conclusion: Meeting 4 of 5 criteria of American College of Rheumatology, diagnosis of AAION was made. The condition was already irreversible at the time of examination.