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November 08, 2016; 87 (19) NeuroImages

Optical coherence tomography in an optic tract lesion

Retinal nerve fiber layer changes

Alexandra J. Lloyd-Smith, Kannan Narayana, Floyd Warren, Laura J. Balcer, Steven L. Galetta, Janet C. Rucker
First published November 7, 2016, DOI: https://doi.org/10.1212/WNL.0000000000003310
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A 49-year-old woman, status post temporal lobe resection, reported a hemianopia. Examination revealed a right afferent pupillary defect, horizontal bow-tie atrophy OD (temporal and nasal), and temporal atrophy OS. Optical coherence tomography showed a bow-tie pattern OD and predominant superior and inferior nerve fiber layer loss OS (figure 1; figure e-1 at Neurology.org). The pattern OD is due to the combination of papillomacular bundle and nasal RNFL loss. The pattern OS is due to nerve fiber layer loss temporal to the fovea and, coupled with papillomacular bundle loss, produces temporal pallor.1 MRI confirmed left optic tract atrophy (figure 2). Optical coherence tomography may be sensitive for detecting localizing atrophic patterns.2

Figure 1
Figure 1 Spectral-domain OCT reveals a bow-tie atrophy pattern in the right eye and predominant superior and inferior nerve fiber layer loss in the left eye

OCT = optical coherence tomography; OD = oculus dexter (right eye); OS = oculus sinister (left eye); RNFL = retinal nerve fiber layer.

Figure 2
Figure 2 Axial T2-weighted MRI

Atrophy of the left optic tract (arrow) and encephalomalacia of adjacent temporal lobe are seen.

Footnotes

  • Supplemental data at Neurology.org

  • Author contributions: Study concept and design: A.J.L.-S., K.N., S.L.G., J.C.R. Acquisition of data: A.J.L.-S., K.N., F.W., J.C.R. Analysis and interpretation: A.J.L.-S., K.N., F.W., J.C.R., S.L.G. Critical revision of the manuscript for important intellectual content: L.J.B., S.L.G., J.C.R. Study supervision: L.J.B., S.L.G., J.C.R.

  • Study funding: No targeted funding reported.

  • Disclosure: The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.

References

  1. 1.↵
    1. Newman SA,
    2. Miller NR
    . Optic tract syndrome: neuro-ophthalmologic considerations. Arch Ophthalmol 1983;101:1241–1250.
    OpenUrlCrossRefPubMed
  2. 2.↵
    1. Goto K,
    2. Miki A,
    3. Yamashita T, et al
    . Sectoral analysis of the retinal nerve fiber layer thinning and its association with visual field loss in homonymous hemianopia caused by post-geniculate lesions using spectral-domain optical coherence tomography. Graefes Arch Clin Exp Ophthalmol 2016;254:745–756.
    OpenUrlPubMed
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