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KMID : 0360220110520070893
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Journal of the Korean Ophthalmological Society
2011 Volume.52 No. 7 p.893 ~ p.896
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Acute Bilateral Visual Loss with Idiopathic Hypertrophic Pachymeningitis
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Lee Yeon-Hee
Kim Jung-Yeul
Nam Ki-Yup
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Abstract
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Purpose:To report a case of bilateral optic neuropathy related with idiopathic hypertropic pachymeningitis.
Case Summary:A 66-year old woman presented with acute visual loss that developed 6 days previously in the right eye and 3 days prior in the left eye. During the initial evaluation, her visual acuity was light perception in the right eye and counting fingers at 30 cm in the left eye. A relative afferent papillary defect (RAPD) was noted in the patient’s right eye. On brain MRI, the duramater was thickened and enhanced by contrast. The erythrocyte Sedimentation Rate (ESR) and C-reactive protein (CRP) level were increased and myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) as positive. Other neurological and medical abnormalities were not found. Under the suspicion of bilateral optic neuropathy due to idiopathic hypertrophic pachymeningitis, the patient was treated with methylprednisolone pulse therapy. Two days after the treatment, the visual acuity was hand movements at 20 cm in the right eye and 0.6 in the left eye. Three months after the treatment, the visual acuity was counting fingers at 20 cm in the right eye, and 0.7 in the left eye. The right eye showed optic disc pallor and diffuse retinal nerve fiber layer (RNFL) defect. The left eye showed a suspicious RNFL defect, and was otherwise normal.
Conclusions:The authors report a rare case of optic neuropathy related with idiopathic hypertrophic pachymeningitis. Idiopathic hypertrophic pachymeningitis should be considered as one of the various causes of optic neuropathy.
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KEYWORD
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Idiopathic hypertrophic pachymeningitis, Optic neuropathy
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