Optic Neuritis – neurosarcoid

Today for conference we discussed a case of a young African-American patient with 2 week history of monocular painful vision loss, neuro exam was consistent with central scotoma but otherwise normal including fundoscopic exam. MRI showed optic neuritis. Vague previous symptoms led to obtaining chest CT which showed bilateral hilar lymphadenopathy – they were subsequently diagnosed with pulmonary and neurosarcoidosis. Some more information here: optic neuritis – 12.6

Take home points:

  • Correlation of eye and orbit anatomy with symptoms can help you determine location of pathology

  • Different causes of vision loss can be broken down into media, retina, and visual pathway based on exam findings

  • Optic neuritis is highly associated with MS but can be associated with other inflammatory / infectious / neoplastic systemic illnesses

  • Neurosarcoidosis should be suspected in sarcoidosis patients with neurological symptoms but sometimes can be the first presentation of a systemic inflammatory disease

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