Optic disc edema and visual loss from paracentral acute middle maculopathy mimicking optic neuritis

Optic neuritis is an important cause of unilateral and acute visual loss in young adults, but other differential diagnoses should be considered, especially when the disease has an atypical presentation. This report presents the case of a young woman with reduced visual acuity in her right eye, associated with optic disc edema and a relative afferent pupillary defect, that was initially misdiagnosed as optic neuritis and subsequently found to have paracentral acute middle maculopathy, possibly secondary to subtle impending central retinal vein occlusion. This case emphasizes the need to remember that retinal vascular diseases can occasionally mimic optic neuritis. Detailed anamnesis and ophthalmic examination can avoid unnecessary interventions.

Keywords:
Optic disc; Papilledema; Optic neuritis; Retinal diseases; Diagnosis, differential; Visual acuity; Diagnostic errors

Authorship

Clarissa R. Pereira

Significant contribution to conception and design

Data acquisition

Data analysis and interpretation

Manuscript drafting

Significant intellectual content revision of the manuscript

Final approval of the submitted manuscript

Statistical analysis

Division of Ophthalmology, Laboratory of Investigation in Ophthalmology Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BrazilUniversidade de São PauloBrazilSão Paulo, SP, BrazilDivision of Ophthalmology, Laboratory of Investigation in Ophthalmology Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil

https://orcid.org/0000-0001-5006-0288

Thais S. A. Benassi

Significant contribution to conception and design

Data acquisition

Data analysis and interpretation

Significant intellectual content revision of the manuscript

Final approval of the submitted manuscript

Statistical analysis

https://orcid.org/0000-0003-0518-1771

Luiz Guilherme M. Mello

Significant contribution to conception and design

Data analysis and interpretation

Significant intellectual content revision of the manuscript

Final approval of the submitted manuscript

Statistical analysis

Department of Specialized Medicine, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Vitória, ES, BrazilUniversidade Federal do Espírito SantoBrazilVitória, ES, BrazilDepartment of Specialized Medicine, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Vitória, ES, Brazil

https://orcid.org/0000-0001-8347-2393

Leonardo P. Cunha

Significant contribution to conception and design

Data analysis and interpretation

Significant intellectual content revision of the manuscript

Final approval of the submitted manuscript

Statistical analysis

Universidade Federal de Juiz de Fora, Juiz de Fora, MG, BrazilUniversidade Federal de Juiz de ForaBrazilJuiz de Fora, MG, BrazilUniversidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil

https://orcid.org/0000-0001-7984-1790

Rony Carlos Preti

Significant contribution to conception and design

Data analysis and interpretation

Significant intellectual content revision of the manuscript

Final approval of the submitted manuscript

Statistical analysis

https://orcid.org/0000-0002-4395-6761

Leandro C. Zacharias

Significant contribution to conception and design

Data analysis and interpretation

Significant intellectual content revision of the manuscript

Final approval of the submitted manuscript

Statistical analysis

https://orcid.org/0000-0003-2965-3315

Eduardo C. de Souza

Data analysis and interpretation

Significant intellectual content revision of the manuscript

Final approval of the submitted manuscript

Statistical analysis

https://orcid.org/0000-0002-0045-1173

Mário L. R. Monteiro Corresponding author: Mário L. R. Monteiro. E-mail: mlrmonteiro@terra.com.br

Significant contribution to conception and design

Data acquisition

Data analysis and interpretation

Manuscript drafting

Significant intellectual content revision of the manuscript

Final approval of the submitted manuscript

Statistical analysis

Monteiro Supervision of administrative, technical, or material support

Research group leadership

https://orcid.org/0000-0002-7281-2791

Corresponding author: Mário L. R. Monteiro. E-mail: mlrmonteiro@terra.com.br

Disclosure of potential conflicts of interest: None of the authors have any potential conflicts of interest to disclose.

Approved by the following research ethics committee: Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (CAAE: 66585623.2.0000.0068).

SCIMAGO INSTITUTIONS RANKINGS

Universidade Federal de Juiz de Fora, Juiz de Fora, MG, BrazilUniversidade Federal de Juiz de ForaBrazilJuiz de Fora, MG, BrazilUniversidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil

Figures

Figures (4)

Thumbnail

Figure 1
Fundus photograph of the right and left eyes at presentation. Note mild optic disc edema inferiorly, a few peripapillary hemorrhages, and subtle venous congestion in the right eye (left image) compared with the normal left eye (right image).

Thumbnail

Figure 2
Automated perimetry of the right eye (Humphrey, 24-2 SITA-Standard test) showing scattered points of reduced sensitivity.

Thumbnail

Figure 3
(A) SD-OCT of the peripapillary nerve fiber layer revealing slightly increased thickness in the lower quadrant of the OD, confirming the presence of mild optic disc edema in this eye. (B) SD-OCT of macular ganglion cell layer thickness was diffusely reduced on the right eye and normal on the left eye.

Thumbnail

Figure 4
(A) B-scan of the macula exhibiting a hyperreflective band in the INL (white arrow) of the OD, particularly of PAMM. (B) En face OCT imaging shows areas of hyperreflectivity around venules in a fern-like appearance (white arrow), and macular ischemia is observed as irregularity in foveal avascular zone capillaries in OD.

Figure 1 Fundus photograph of the right and left eyes at presentation. Note mild optic disc edema inferiorly, a few peripapillary hemorrhages, and subtle venous congestion in the right eye (left image) compared with the normal left eye (right image).

Figure 2 Automated perimetry of the right eye (Humphrey, 24-2 SITA-Standard test) showing scattered points of reduced sensitivity.

Figure 3 (A) SD-OCT of the peripapillary nerve fiber layer revealing slightly increased thickness in the lower quadrant of the OD, confirming the presence of mild optic disc edema in this eye. (B) SD-OCT of macular ganglion cell layer thickness was diffusely reduced on the right eye and normal on the left eye.

Figure 4 (A) B-scan of the macula exhibiting a hyperreflective band in the INL (white arrow) of the OD, particularly of PAMM. (B) En face OCT imaging shows areas of hyperreflectivity around venules in a fern-like appearance (white arrow), and macular ischemia is observed as irregularity in foveal avascular zone capillaries in OD.

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Optic disc edema and visual loss from paracentral acute middle maculopathy mimicking optic neuritis

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[1] Corresponding author: Mário L. R. Monteiro. E-mail: mlrmonteiro@terra.com.br