A 42-year-old African American woman with a 5-year history of neuromyelitis optica was found to have an incongruous homonymous hemianopia. Optical coherence tomography (OCT) showed corresponding left homonymous hemimacular thinning. Magnetic resonance imaging of the brain demonstrated a demyelinating lesion in the left optic tract (OT) just anterior to the lateral geniculate nucleus and diffusion tensor magnetic resonance tractography confirmed axonal fiber loss in the left OT. This case illustrates the complementary and confirmatory roles of visual field testing, macular OCT, and neuroimaging in an OT lesion, which caused selective hemimacular thinning through retrograde degeneration.
Department of Neurology (RSR, IG, EW, ATR, JTB, AJ), University of Chicago, Chicago, Illinois; and Departments of Ophthalmology and Medicine, Division of Neurology (MTB), Duke Eye Center and Duke University Medical Center, Durham, North Carolina.
Address correspondence to Adil Javed, MD, PhD, Department of Neurology, University of Chicago, 5841 South Maryland Avenue, MC 2030, Chicago, IL 60637; E-mail: email@example.com
Supported by Biogen grant US-TYS-09-10019 (Bernard) and fellowship funds from Teva Pharmaceuticals and National Multiple Sclerosis Society (Romero).
Dr Romero has received honoraria for speaking engagements from Bayer Healthcare, Teva Pharmaceuticals, and Novartis. She also received fellowship support from Teva Pharmaceuticals. Dr Bhatti has served as a consultant and is on the speaker bureau for Bayer healthcare, Pfizer, Serono, and Novartis. Dr Bernard is on the speaker bureau for Novartis and Bayer and consultant for Biogen. Dr Javed has served as a consultant and is on the speaker bureau for Bayer HealthCare, Biogen, Teva Pharmaceuticals, Serono, Novartis, and Questcor. Dr Reder has served as a consultant and is on the speaker bureau for Bayer Schering Pharma AG/Bayer HealthCare Pharmaceuticals, Biogen, Hoffman La Roche, Merck-Serono, Novartis, Sanofi-Aventis, Serono Symposia, and Teva Pharmaceuticals. Mr Gutierrez and Dr Wang have nothing to disclose.