Ischemic optic neuropathy despite pulse methylprednisolone therapy in a giant cell arteritis patient with perineural optic nerve enhancement

Tashiro, Takumi; Tsujimoto, Atsushi; Nakamura, Nobuhiro

doi:10.5692/clinicalneurol.cn-001643

Cited by 3 publications

(3 citation statements)

References 21 publications

(1 reference statement)

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“…When reported, ophthalmologic outcomes improved (9%), remained stable (33%), or worsened (7%) at follow-up. Seven cases reported follow-up MR exams, among which 6 cases [21; 25; 30; 35; 37; 38] reported resolution and 1 case [39] reported no improvement.…”

Section: Resultsmentioning

confidence: 99%

“…The ESR and CRP were both normal in 8% of cases (N=2/26) [21; 22]. Five cases reported platelet counts, with thrombocytosis (above 450 × 10 9 /L) in 3 of the cases [23-25].…”

Section: Resultsmentioning

confidence: 99%

“…Additional areas of future investigation include whether MRI could help determine when corticosteroids/immunomodulatory treatments could be tapered, if MRI can detect relapse or whether MRI has a prognostic role for determining ophthalmologic outcomes. Several cases [21; 30; 35; 37; 38] reported resolution of pathologic enhancement on orbital MRI and improvement in visual function/symptoms while another case [25] reported no visual functional improvement despite imaging resolution. Alternatively, optical coherence tomography/-angiography can image the retinal layer and assess microvascular changes, respectively.…”

Section: Discussionmentioning

confidence: 99%

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Orbital Magnetic Resonance Imaging of Ocular Giant Cell Arteritis: A Systematic Review and Individual Participant Data Meta-Analysis

Guggenberger

Pavlou

Cao

et al. 2022

Preprint

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Objectives: Spectrum and prevalence of orbital MRI findings in patients with giant cell arteritis with ischemic optic neuropathy are unknown. We conducted a systematic review and individual participant data meta-analysis of publications reporting the ophthalmologic presentation, clinical exam, and orbital MRI findings in ocular giant cell arteritis. Methods: PubMed and Cochrane databases were searched from inception to January 16, 2022. Publications reporting patient-level data on patients with ophthalmic symptoms, imaged with orbital MRI and diagnosed with biopsy-proven giant cell arteritis were included. Demographics, clinical symptoms, exam, lab, imaging, and outcomes data were extracted. Descriptive statistics were used to report prevalence rates. Methodological quality and completeness of reporting of the case reports were assessed. Results: Thirty-two studies were included comprising 51 patients (females=24; median age, 76 years). Vision loss (78%) and headache (45%) were commonly reported visual and cranial symptoms. Ophthalmologic presentation was unilateral (41%) or bilateral (59%). Fundus examination most commonly showed disc edema (64%) and pallor (49%). Average visual acuity was very poor (2.28 logMAR ± 2.18). Diagnoses included anterior (61%) and posterior (16%) ischemic optic neuropathy, central retinal artery occlusion (8%) and orbital infarction syndrome (2%). Erythrocyte sedimentation rate and c-reactive protein were elevated in 83% and 42% of cases, respectively. On MRI, enhancement of the optic nerve sheath (53%), intraconal fat (25%), and optic nerve/chiasm (14%) was most prevalent. Among patients with monocular visual symptoms, 38% showed pathologic enhancement in the asymptomatic orbit. Six of seven cases reported imaging resolution after treatment on follow-up MRIs. Incomplete reporting were limitations in this study. Conclusions: Vision loss, pallid disc edema, and optic nerve sheath enhancement are the most common clinical, fundoscopic and imaging findings reported in patients diagnosed with ocular giant cell arteritis, respectively. MRI may detect subclinical inflammation in the asymptomatic eye and may be an adjunct diagnostic tool.

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Section: Resultsmentioning

confidence: 99%

“…The ESR and CRP were both normal in 8% of cases (N=2/26) [21; 22]. Five cases reported platelet counts, with thrombocytosis (above 450 × 10 9 /L) in 3 of the cases [23-25].…”

Section: Resultsmentioning

confidence: 99%