Ischemic Optic Neuropathy Secondary to Intravascular Lymphoma

Background: To describe a case of optic neuropathy associated with intravascular lymphoma (IVL). Methods: Case report and review of the literature. Results: A case of asymmetric binocular vision loss is described, preceded by transient vision loss. Associated optic perineural enhancement and enhancing and diffusion-positive cortical lesions were observed on magnetic resonance imaging. Biopsy of the cerebellum revealed exclusively intraluminal neoplastic B-cells consistent with IVL. Conclusions: Patients with IVL may rarely present with optic nerve involvement, presumably due to small vessel occlusion. The presentation may mimic features of anterior ischemic optic neuropathy including an acute onset and disc edema. Although optic nerve enhancement and associated white matter lesions may suggest optic neuritis, enhancement of the optic nerve sheath, as in this case, has a wide differential diagnosis, which includes giant cell arteritis. IVL should be considered in atypical cases of optic neuropathy accompanied by enhancing, diffusion-positive brain lesions that are not within a specific vascular territory. Address correspondence to Marc Dinkin, MD, Weill Cornell Ophthalmology, 1305 York Avenue, 11th Floor, New York, NY 10065; E-mail: mjd2004@med.cornell.edu The authors report no conflicts of interest. © 2018 by North American Neuro-Ophthalmology Society

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