Neuromyelitis optica presenting with bitemporal hemianopia
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
AbstractNeuromyelitis 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.
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