case_images: PMC11182202_01
case_images: Fundus photographs and automated perimetry at presentation. (A, B), Color fundus photographs demonstrating an asymmetric right greater than left optic disc edema. (C), Visual field examination demonstrating right superior quadrantanopia in the right eye, which is presumed to be due to a previous left temporal ganglioglioma resection. The left eye was unable to perform automated perimetry due to decreased vision.
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case_images: A fundus examination revealed moderate disc edema in the right eye and mild edema in the left eye ( Figure 1 ).
case_images: MRI/MRV brain and orbit scans with gadolinium at presentation. (A-D), Axial and coronal T1-weighted postcontrast fat-saturated images, 13 years after a left temporal lobe tumor resection, which demonstrate postoperative changes with diffuse, smooth dural enhancement over the frontal and temporal lobes (arrowheads). (E), Coronal 2D TOF MRV scan showing a congenitally hypoplastic right transverse sinus, and, to a lesser extent, the right sigmoid sinus and the proximal right jugular vein. There was no evidence of a dural sinus thrombosis or findings that were suggestive of an elevated intracranial pressure on neuroimaging.
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case_images: MRI demonstrated diffuse pachymeningeal thickening and left temporal enhancement, which was initially presumed consistent with the history of tumor resection, but no optic nerve enhancement. Magnetic resonance venography (MRV) showed anatomical variation in the right transverse sinus, the hypoplastic right sigmoid, and the right internal jugular veins ( Figure 2 ).
case_images: Bilateral optic neuropathy and retinopathy at presentation. (A, B), Widefield fundus color photographs demonstrating an asymmetric right greater than left optic disc edema and numerous patchy RPE abnormalities of the left posterior pole that are consistent with inflammatory lesions. (C, D), High-magnification view of macular subretinal lesions. (E, F), Circumpapillary RNFL thickening is most pronounced in the superior and inferior temporal quadrants OD and superior and inferior quadrants OS. (G-J), Macula OCT with ganglion cell segmentation demonstrating asymmetric ganglion cell layer thinning, and left eye intraretinal cystoid changes of the inner nuclear layer. (K, L), Widefield late-phase fluorescein angiograms showing no peripapillary leakage, vascular leakage, or capillary non-perfusion.
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case_images: Notably, the retinal examination of the left eye revealed subtle infiltrates cuffing around the retinal vessels along the superior and inferior arcades ( Figure 3 ).
case_images: Follow-up post immunosuppressive treatment. (A, B), Axial and coronal T1-weighted postcontrast fat-saturated images after treatment with steroids and IVIG demonstrates a significant interval decrease in dural thickening, with only minimal residual enhancement. (C, D), Widefield fundus photographs demonstrating an improvement in optic nerve edema of both eyes, a marked temporal pallor of the left eye, and resolution of multifocal subretinal infiltrates along the superior and inferior temporal arcades of the left eye. (E, F), Circumpapillary RNFL thickening improved OD and demonstrated inferotemporal thinning OS. (G), Automated perimetry demonstrating an improvement in right superior quadrantanopia, which was previously thought to be due to a ganglioglioma resection.
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case_images: At the 3-month follow-up, the patient's visual acuity improved so that he could count fingers with the left eye, with the right eye demonstrating a significant improvement in the right superior quadrantanopia ( Figure 4 ).