Diffusion restriction of the optic nerve in patients with acute visual deficit

Bender, Benjamín; Heine, Christian; Danz, S.; Bischof, Felix; Reimann, Katrin; Bender, Miriam; Nägele, Thomas; Ernemann, Ulrike; Korn, A.

doi:10.1002/jmri.24367

Cited by 51 publications

(37 citation statements)

References 21 publications

(32 reference statements)

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“…It has been proposed that diffusion-weighted MR imaging may differentiate ischemic optic neuropathy from optic neuritis (6). In a recent study, diffusion-weighted imaging was abnormal in 5/5 patients with acute ischemic optic neuropathy, but only 2/25 patients with acute optic neuritis (7). The mean apparent diffusion coefficient was 0.55 × 10 -3 mm 2 /s in acute ischemic optic neuropathy and 1.10 × 10 -3 mm 2 /s in acute optic neuritis.…”

Section: Discussionmentioning

confidence: 94%

Reduced Apparent Diffusion Coefficient in Neuromyelitis Optica–Associated Optic Neuropathy

Horton

Douglas

2015

Journal of Neuro-Ophthalmology

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Diffusion-weighted magnetic resonance imaging is a useful tool to differentiate between acute ischemic and demyelinating lesions. In ischemic optic neuropathy the diffusion of water is impaired, but in optic neuritis it usually remains normal. We describe a patient with optic neuritis and aquaporin-4 autoantibodies, in whom imaging revealed prolonged reduction of the apparent diffusion coefficient. Immune-mediated destruction of water channels apparently decreased movement of fluid through the inflamed nerve. Diffusion-weighted imaging may distinguish optic neuritis associated with aquaporin-4 antibodies from the more common form that occurs in conjunction with multiple sclerosis.

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Section: Discussionmentioning

confidence: 94%

Reduced Apparent Diffusion Coefficient in Neuromyelitis Optica–Associated Optic Neuropathy

Horton

Douglas

2015

Journal of Neuro-Ophthalmology

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“…18 The frequency of restricted diffusion in optic neuritis is not clear; however, one retrospective study found that 8% of patients with clinical optic neuritis showed restricted diffusion on DWI. 19,20 Furthermore, changes within the optic nerve are more commonly seen with gadolinium enhanced imaging, 20 a feature not usually associated with acute ischaemic lesions.…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

Using Diffusion-Weighted Magnetic Resonance Imaging to Confirm a Diagnosis of Posterior Ischaemic Optic Neuropathy: Two Case Reports and Literature Review

Quddus

Lawlor

Siddiqui

et al. 2015

Neuro-Ophthalmology

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Posterior ischaemic optic neuropathy is a rare cause of visual loss believed to be due to infarction in the territory of the pial branches of the ophthalmic artery. The disorder most commonly occurs in the context of prolonged surgery or giant cell arteritis, and the absence of clinical signs in the eye means that the diagnosis is one of exclusion. Here, we present two cases studies of patients who developed posterior ischaemic optic neuropathy confirmed by the observation of secondary changes on diffusion-weighted imaging sequences. In the first case visual loss followed robotic pelvic surgery, and in the second case it was associated with multiorgan dysfunction secondary to severe pancreatitis. Our cases demonstrate that in the right clinical context, diffusion-weighted imaging can provide a positive diagnosis of acute posterior ischaemic optic nerve injury in the acute phase.

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“…83,84 Findings that would not be associated with typical optic neuritis would include a compressive lesion such as a meningioma, an optic nerve glioma or lymphoma, optic nerve sheath enhancement combined with other cranial nerve enhancement as seen in granulomatous disease such as sarcoidosis (Fig. 10), sequela of radiation therapy (Fig.…”

Section: Mukhi and Lincolnmentioning

confidence: 98%

MRI in the Evaluation of Acute Visual Syndromes

Mukhi

Lincoln²

2015

Topics in Magnetic Resonance Imaging

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Acute visual symptom emergencies occur commonly and present a challenge to both clinical and radiologic facets. Although most patients with visual complaints routinely require clinical evaluation with direct ophthalmologic evaluation, imaging is rarely necessary. However, there are highly morbid conditions where the prompt recognition and management of an acute visual syndrome (AVS) requires an astute physician to probe further. Suspicious symptomatology including abrupt visual loss, diplopia, ophthalmoplegia, and proptosis/exophthalmos require further investigation with advanced imaging modalities such as magnetic resonance imaging and magnetic resonance angiography. This review will discuss a variety of AVSs including orbital apex syndrome, cavernous sinus thrombosis, cavernous carotid fistula, acute hypertensive encephalopathy (posterior reversible encephalopathy syndrome), optic neuritis, pituitary apoplexy including hemorrhage into an existing adenoma, and idiopathic intracranial hypertension. A discussion of each entity will focus on the clinical presentation, management and prognosis when necessary and finally, neuroimaging with emphasis on magnetic resonance imaging. The primary purpose of this review is to provide an organized approach to the differential diagnosis and typical imaging patterns for AVSs. We have provided a template for radiologists and specialists to assist in early intervention in order to decrease morbidity and provide value-based patient care through imaging.

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Diffusion restriction of the optic nerve in patients with acute visual deficit

Abstract: DWI can identify ischemic lesions of the optic nerve. As in acute multiple sclerosis lesions, optic neuritis can also present in rare circumstances with diffusion restriction and can therefore not be ruled out solely by DWI MRI.

Cited by 51 publications

References 21 publications

Reduced Apparent Diffusion Coefficient in Neuromyelitis Optica–Associated Optic Neuropathy

Reduced Apparent Diffusion Coefficient in Neuromyelitis Optica–Associated Optic Neuropathy

Using Diffusion-Weighted Magnetic Resonance Imaging to Confirm a Diagnosis of Posterior Ischaemic Optic Neuropathy: Two Case Reports and Literature Review

MRI in the Evaluation of Acute Visual Syndromes

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