Neuromyelitis optica presenting with bitemporal hemianopia

Irina Effendi Tenang, Nurliza Binti Khaliddin, Norlisah Ramli, Mimiwati Zahari

Abstract


Neuromyelitis optica (NMO) is an idiopathic immune-mediated inflammatory disease of the central nervous system (CNS) characterized by severe demyelination and axonal damage with a predilection for the optic nerves and spinal cord.  In this case report, a 60-year-old woman presented with decreased vision.  Visual field testing initially demonstrated a bitemporal inferior quadrantinopia which progressed to a bitemporal hemianopia.  The patient did not have any focal neurologic deficits.  Indirect immunofluorescence testing was performed and positive for serum anti-aquaporin 4 (AQP4) antibodies indicating a diagnosis of NMO.  The bitemporal hemianopia largely resolved following intravenous steroids.  However, she developed a relapse of her NMO requiring restarting of the intravenous steroids.  The patient was diagnosed with chiasmal neuritis.  A variety of visual field defects may be seen in optic neuropathies, but typically in NMO, a central scotoma or altitudinal hemianopia is the most frequent visual field defect in patients with optic neuritis; bitemporal hemianopia is exceedingly rare.

Keywords


neuromyelitis optica; neuromyelitis optica spectrum disorder; nmo; nmosd; bitemporal; inferior; quadrantinopia; quadrantinopsia; hemianopia; hemianopsia; cerebral lesion; optic neuritis; chiasmal neuritis; multiple sclerosis; intravenous steroids

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DOI: http://dx.doi.org/10.16964/er.v6i1.91

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