Orbit/Optic Nerve Inflammation - Postseptal 1, MR
Claim CME CreditPOINT OF CARE INFORMATION
This CME activity consists of the student reviewing the video of the professor reviewing the case as well as the associated DICOM image set related to the case in question.
Learning Objectives
As a result of participation in this activity, participants should be able to:
- Provide improved patient care.
- Greater knowledge of the imaging characteristics of the patient's disease.
- Understand a better approach to interpretation of studies.
Faculty Disclosure
Mehmet Albayram, MD, Ivan Davis, MD, Mariam Hanna, MD, Anthony Mancuso, MD, Ronald Quisling, MD, Dhanashree Rajderkar, MD, Priya Sharma, MD, Roberta Slater, MD and Joann Stamm, MBA have disclosed that they have no relevant financial relationships. No one else is a position to control content have any financial relationship to disclose.
CME Advisory Committee Disclosure:
Conflict of interest information for the CME Advisory Committee members can be found on the following website: https://cme.ufl.edu/disclosure/.
Continuing Medical Education Credit
Accreditation: The University of Florida College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Credit: The University of Florida College of Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
CA0428-Orbit/Optic Nerve Inflammation - Postseptal 1, MR
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CA0428-Orbit/Optic Nerve Inflammation - Postseptal 1, MR
Case ReportHistory
Exam
Prior Study
Findings
Orbit, sinonasal, cavernous and skull base
There is no primary sinonasal, bone or skull base rather than a primary orbital disease process that might be causative and producing the patient’s painful right eye and visual loss.
The pre-septal soft tissues are minimally swollen and lacrimal gland is likely slightly inflamed. There generalized edema and increase vascularity within the intraconal compartment. The extraocular muscles do not appear to be swollen or otherwise abnormal. The orbital apex and superior orbital fissure are not infiltrated, edematous or otherwise abnormal.
There is no enlargement and/or thrombosis of the superior, inferior or other orbital veins no evidence of cavernous sinus thrombosis or inflammation.
Eyes
Proptosis is not present and there is no evidence of tension orbit.
There is minimal enhancement of the sclera adjacent to the attachment of the optic sheath. There is no hemorrhage or other abnormality causing a detachment of the choroid, hyaloid membrane and/or retina. The optic disc appears normal. The vitreous body is normal.
The anterior segment structures are normal considering findings consistent with cataract surgery.
Endophthalmitis is not likely present.
Optic nerve/sheath and chiasm
The right optic nerve appears to be edematous and perhaps slightly enlarged near the nerve globe junction. There is abnormal enhancement of the right optic sheath. There is no intraconal compressive lesion but there is evidence of edema surrounding the optic sheath for most of its course through the muscle cone although the orbital apex is spared and there is no abnormality involving the cavernous sinus.
There is no abnormal meningeal or other enhancement of the optic chiasm, optic nerves or other structures in the suprasellar and/or chiasmatic cistern. There is no generalized abnormal meningeal enhancement.
Brain
There are no intra-axial or extra-axial abnormalities of the brain that might be related to the orbital pathology.
There is no evidence of obstructive or communicating hydrocephalus.
Impression
Lymphoma
Peri-neuritic pseudotumor
Peri-neuritic pseudotumor or possibly optic nerve and sheath manifestations of other immune mediated disease, granulomatous vasculitis or rarely chronic infections such as syphilis.
