Open AccessEnlarged and Enhancing Optic Nerves in Advanced Glial Fibrillary Acidic Protein Meningoencephalomyelitis
Author(s) -
Daniel A. White,
Susan P Mollan,
Satheesh Ramalingam,
Santhoosh Nagaraju,
Tom Hayton,
Saiju Jacob
Publication year - 2019
Publication title -
journal of neuro-ophthalmology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.586
H-Index - 55
eISSN - 1536-5166
pISSN - 1070-8022
DOI - 10.1097/wno.0000000000000842
Subject(s) - pleocytosis , glial fibrillary acidic protein , cerebrospinal fluid , optic nerve , medicine , pathology , intracranial pressure , papilledema , vomiting , csf albumin , optic neuritis , meningitis , nausea , lumbar , anatomy , ophthalmology , radiology , immunohistochemistry , surgery , multiple sclerosis , immunology
A 36-year-old woman presented with intermittent fever, nausea and vomiting, generalized polyarthralgias, and bilateral optic disc swelling. She had a history of difficult-to-control myasthenia gravis since the age of 18 years. Lumbar puncture demonstrated a normal opening pressure; cerebrospinal fluid (CSF) was remarkable for high protein, low glucose, and a mononuclear pleocytosis. Although initial MRI of the brain was normal, a repeat study 8 weeks later revealed enlarged and enhancing bilateral intraorbital and intracranial optic nerves. After a nondiagnostic brain biopsy, a CSF sample tested positive for antibodies to glial fibrillary acidic protein (GFAP). Findings in this case indicate that optic nerve swelling encountered in GFAP meningoencephalomyelitis is more likely due to optic nerve inflammation rather than elevated intracranial pressure.