A 45-year-old woman presented with sudden complete vision loss in her left eye and retroorbital pain worsened by eye movements. A previous milder episode of vision loss had occurred in the same eye 1 year before, with complete recovery after high-dose intravenous methylprednisolone. She had no light perception in the left eye with a swollen optic disc, but with a normal right optic disc. There were no systemic manifestations or infections. MR scan of the brain showed extensive enlargement and enhancement of the left optic nerve and optic chiasm. After excluding infections and autoimmune markers, a left optic nerve biopsy confirmed non-caseating granulomas, leading to a diagnosis of neurosarcoidosis.
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Contributors Conceptualization and design of the report: PF, FMRF, JLP and OGPB. Collection of data: PF, ALV, MESFB, NLS and VLB. Literature review: PF, ALV, MESFB, NLP, VLB and MPM. Drafting of the manuscript: PF, VLB and FMRF. Critical revision of manuscript: MPM, JLP and OGPB. All authors have reviewed and approved the final version of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally reviewed by Neil Scolding, Bristol, UK.