MRI, with fat suppression, of a 42-year-old woman presenting with severe brow pain and 4 days of progressive visual loss OD showed enhancement of the right optic nerve and streaky enhancement of the orbital fat. Examination had also shown considerable right optic disc edema and right relative pupillary defect. Her vision deteriorated to no light perception, with an amaurotic right pupil. After treatment with penicillin and Solu-Medrol for 14 days for what was believed to be syphilitic optic neuritis and perineuritis, she had rapid resolution of pain, no relative afferent pupillary defect, and only traces of residual disc edema.
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