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Unilateral optic neuropathy following subdural hematoma: a case report

DOI: 10.1186/1752-1947-4-19

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A 70-year-old Caucasian German who developed a massive left hemispheric subdural hematoma under oral anticoagulation presented with acute, severe visual impairment on his left eye, which was noticed after surgical decompression. Neurologic and ophthalmologic examinations indicated sinistral optic neuropathy with visual acuity reduced nearly to amaurosis. Ocular pathology such as vitreous body hemorrhage, papilledema, and central retinal artery occlusion were excluded. An orbital lesion was ruled out by means of orbital magnetic resonance imaging. However, cerebral diffusion-weighted imaging and T2 maps of magnetic resonance imaging revealed a circumscribed ischemic lesion within the edematous, slightly herniated temporomesial lobe within the immediate vicinity of the affected optic nerve. Thus, the clinical course and morphologic magnetic resonance imaging findings suggest the occurrence of pressure-induced posterior ischemic optic neuropathy due to microcirculatory compromise.Although lesions of the second cranial nerve following subdural hematoma have been reported individually, their pathogenesis was preferentially proposed from autopsy studies. Here we discuss a dual, pressure-induced and secondarily ischemic pathomechanism on the base of in vivo magnetic resonance imaging diagnostics which may remain unconsidered by computed tomography.Unilateral optic neuropathy (ON) following subdural hematoma has been confirmed by necropsy studies. In these studies, microcirculatory compromise of the optic nerve was proven as a pathogenic mechanism [1]. In this case report, diffusion-weighted images (DWI) of magnetic resonance imaging (MRI) scans showed signal alteration in the ipsilateral optic nerve as a strong evidence for the development of microvascular deficit. Thus, our case is in line with results from autopsies. To the best of our knowledge, this is the first case presentation that demonstrates microvascular impairment with optic neuropathy in vivo.A 70-year-old Cau


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