The Effectiveness of MRI Scans in Diagnosing Neurosarcoidosis in Late-stage Glaucomatous Optic Neuropathy Patients: A Case Report

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  • Akashi Mari
    Department of Ophthalmology, Osaka City General Hospital Department of Ophthalmology, Osaka Women’s and Children’s Hospital
  • Shimozono Masataka
    Department of Ophthalmology, Osaka City General Hospital
  • Inoue Manabu
    Department of Neurology, Osaka City General Hospital

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  • 後期の緑内障性視神経症患者にMRI撮影により 神経サルコイドーシスと診断できた症例

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Abstract

<p>　In cases of late or end-stage glaucoma, it is often easy to overlook changes to the optical nerve and vision field due to an already low visual function and pale discs. In this case, new lesions of neurosarcoidosis were successfully diagnosed in a patient with late stage glaucoma, using Magnetic Resonance Imaging（MRI）.</p> <p>　A 48-year-old man presented with a sudden decrease in visual acuity in the right eye that had manifested three days prior to his visit. The patient was also being treated for skin sarcoidosis, and 10 years earlier, he was diagnosed with secondary glaucoma with iritis. There was no change to the pale discs. However, compared to his last visit, the patient exhibited a decrease in visual acuity（from 1.7 logMAR to counting finger）and critical fusion frequency of flicker（CFF: from 17 Hz to 0 Hz）in the right eye. Therefore, we decided to perform a contrast-enhanced MRI to check for optic neuritis. In addition to swelling, the MRI revealed multiple nodules along the meninges in the pons, Sylvian fissure, and midbrain. This was consistent with neuritis in both eyes, the abnormality was diagnosed as neurosarcoidosis.</p> <p>　The patient underwent a three-day course of pulse steroid therapy. We were unable to record any measured improvement in VA or CFF. The Goldmann visual field test revealed increased sensitivity in both eyes and improvement to the degree of visual field（VF）in the left eye.</p> <p>　If unusual and sudden changes occur in patients with late glaucoma, MRI scans could be effective in diagnosing other abnormalities present in the optic nerves or the brain.</p>

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