Bilateral Optic Nerve Sheath Enhancement from Giant Cell Arteritis
KENNETH E. MORGENSTERN, BRIAN D. ELLIS, SIDNEY S. SCHOCHET, and JOHN V. LINBERG
ABSTRACT.
An 83-year-old man presented with acute bilateral visual loss to no light perception (NLP) OD and 20/50 OS. His fundus examination showed moderate bilateral pallid disc edema. A sedimentation rate was 60 mm/h. Magnetic resonance imaging of the brain and orbits with gadolinium revealed marked bilateral enhancement of the optic nerve sheaths and adjacent orbital fat. He underwent biopsies of the optic sheath OD and bilateral temporal arteries. Histopathology of the optic nerve sheath area revealed fibroadipose tissue containing numerous arteries with intimal thickening, and mild mural inflammation consisting predominantly of lymphocytes with occasional giant cells. The bilateral temporal artery biopsies revealed focal disruption of the elastic lamina with rare giant cells. His vision had since stabilized on IV methylprednisolone therapy. The biopsies of the nerve sheath suggest that the radiologic finding of optic nerve sheath enhancement in giant cell arteritis is caused by the same pathophysiology, and therefore may be a manifestation of this systemic disease.
(J Rheumatol 2003;30:625-7)
Key Indexing Terms:
OPTIC NERVE SHEATH
GIANT CELL ARTERITIS
VISUAL LOSS
OPTIC NEUROPATHY
From the Departments of Ophthalmology and Neuropathology, West Virginia University Hospitals, Morgantown, West Virginia, USA.
K.E. Morgenstern, MD; B.D. Ellis, MD; J.V. Linberg, MD, Department of Ophthalmology; S.S. Schochet, MD, Department of Neuropathology.
Address reprint requests to Dr. K. Morgenstern, Department of Ophthalmology, West Virginia University Hospital, PO Box 9193, Morgantown, WV 26506. E-mail: Kmorgenstern@hsc.wvu.edu
Submitted April 3, 2002; revision accepted August 30, 2002.
