A case of optic chiasmal neuritis with anti-aquaporin 4 antibody presenting bitemporal hemianopsia Sayuri Aoki 1 , Daisuke Todokoro 1 , Yoichiro Shinohara 1 , Toshiyuki Takahashi 2,3 , Hideo Akiyama 1 1Department of Ophthalmology, Gunma University Graduate School of Medicine 2Department of Neurology, Tohoku University School of Medicine 3Department of Neurology, National Hospital Organization Yonezawa Hospital pp.1313-1318
Published Date 2019/10/15
DOI https://doi.org/10.11477/mf.1410213293
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Abstract Purpose:To report a case of chiasmal neuritis with anti-aquaporin 4 antibody presenting bitemporal henianopsia.

Case:A 68-year-old woman presented with bitemporal visual impairment since 2 months.

Findings and Clinical Course:Best-corrected visual acuity was 0.3 right and 0.2 left. Perimetry showed bitemporal hemianopsia. Magnetic resonance imaging(MRI)showed increased contrast of optic chiasm when enhanced with gadolinium. Anti-aquaporin 4(AQP4)was positive and she was diagnosed with optic chiasmal neuritis with anti-AQP4 antibody. She was treated with pulsed therapy with methyloprednisolone. Visual acuity improved to 1.0 right and 0.9 left with improved visual field and decreased gadolinium enhancement of optic chiasm. There has been no recurrence of optic chismal neuritis until present.

Conclusion:Corticosteroid pulse therapy was followed by improvement of chiasmal neuritis with anti-AQP4 antibody. This case illustrates that optic chiasmal neuritis may be the underlying cause for bitemporal hemianopsia even in the absence of tumorous lesion.

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