Posterior Ischemic Optic Neuropathy in the Setting of Posterior Reversible Encephalopathy Syndrome and Hypertensive Emergency

Abstract

We present the magnetic resonance imaging findings of posterior ischemic optic neuropathy in a patient with posterior reversible encephalopathy syndrome secondary to hypertensive emergency.

Utility of standard diffusion-weighted magnetic resonance imaging for the identification of ischemic optic neuropathy in giant cell arteritis

“…In the remaining 3 cases, diagnosis of PION could not be established due to concurrent ocular disease. The results of our systematic investigation support the notion that DWI-MRI is able to visualize optic nerve ischemia in acute PION, as indicated by previous case reports 8 , 10 , 12 , 13 , 16 – 19 , 25 . This finding is of major significance as DWI-MRI allows for an early diagnosis of clinically suspected PION in the acute phase of the disease, thereby possibly reducing the time delay to the initiation of corticosteroid treatment in GCA.…”

“…Cerebral DWI has long been an established method to identify ischemic stroke, which is a feared complication in GCA patients with cranial artery involvement 48 . However, a growing number of case reports [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]49 and systematic studies 26,32,33,50,51 substantiate the presence of DWI abnormalities in non-arteritic ischemic lesions of the optic nerve and retina. Additionally, DTI studies by Fang and Wang et al have observed changes in ON fractional anisotropy in subacute AION of unspecified etiology 52,53 .…”

Invasive Fungal Sinusitis Presenting as Acute Posterior Ischemic Optic Neuropathy

“…Since in the exenteration specimen, devitalized fungal hyphae were identified only in the tissue from the orbital apex, we propose that our patient went blind not from direct neural invasion of the optic nerve by fungus but from acute posterior ischaemic optic neuropathy (PION), perhaps from fungal angio-invasion of small meningeal arteries supplying the optic nerve in and around the optic foramen. 1,2 PION is a difficult clinical diagnosis 3 that can, in some cases, be convincingly validated by showing restricted diffusion along a segment of the optic nerve [4][5][6][7][8][9][10][11][12][13] as in this case. Restricted diffusion along the optic nerve can also occur in PION from septic cavernous sinus thrombosis 14,15 , in traumatic 16 and in lymphomatous optic neuropathy 17 , in optic neuritis 10,18,19 and at the optic disc in papilledema.…”

Posterior Reversible Leukoencephalopathy Syndrome: Clinical Case and Literature Overview

“…Зрительные расстройства у описанного нами пациента заключались в снижении остроты зрения и появлении скотом, а также в возникновении сложных зрительных галлюцинаций. В ряде случаев причиной ухудшения зрения при СЗОЛ выступает обусловленная выраженным отеком компрессионно-ишемическая нейропатия зрительных нервов, характеризующаяся последующим практически полным восстановлением остроты зрения [17].…”

“…Полагают, что для повреждения гематоэнцефалического барьера и развития вазогенного отека имеет значение не только степень повышения АД, но и скорость этого повышения [2,7]. У пациентов с привычно низким уровнем АД критическим может стать его увеличение всего лишь до уровня умеренной гипертензии [17].…”