title: Wegener granulomatosis-associated optic perineuritis.
abstract: INTRODUNCTION: We report two patients with optic perineuritis (OPN) and hypertrophic pachymeningitis in Wegener granulomatosis (WG).
  
  
  METHODS
  Patient 1: a 74-year-old man developed blurred vision in each eye, sequentially, over a year. In the first episode, visual acuity in the right eye was reduced to no light perception, and in the second episode, the vision in the left eye fell to 20/100. Brain and orbital magnetic resonance imaging (MRI) revealed abnormal enhancement in the meninges and the ipsilateral optic nerve sheath. T2-hyperintense lesions were found along the outer rim of the ipsilateral optic nerve. Seropositive proteinase-3-antineutrophil cytoplasmic antibody (PR3-ANCA), microhematuria and multiple pulmonary nodules suggested the diagnosis of WG. Steroid therapy was initiated 3 months after the first onset, but with no clinical response. At the 2nd episode, rapid administration of steroid ameliorated visual disturbance and MRI lesions markedly. Patient 2: a 72-year-old man developed blurred vision in each eye. Visual acuity measured no light perception in OD and 6/12 in OS. Gadolinium-enhanced MRI disclosed enhancement in the meninges and both optic nerve sheaths. T2-weighted imaging displayed hyperintense lesions along the outer rims of optic nerves. Otolaryngologic examination, seropositive PR3-ANCA and pulmonary nodules supported the diagnosis of WG. Steroid and cyclophosphamide treatment improved visual dysfunction and MRI lesions in the meninges and the optic nerve sheaths.
  
  
  CONCLUSIONS
  The morphological similarity and the anatomical continuity between the meningeal and the perioptic tissues suggest that extension of granulomatous inflammation along such tissue planes accounted for visual loss in these two patients with WG.
authors.affiliation: Department of Neurology .
authors.forename: Takanori
authors.initials: T
authors.lastname: Takazawa
authors.forename: Ken
authors.initials: K
authors.lastname: Ikeda
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Nagaoka
authors.forename: Takehisa
authors.initials: T
authors.lastname: Hirayama
authors.forename: Tatsuhiro
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Masaru
authors.initials: M
authors.lastname: Yanagihashi
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Tochikubo
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Iwasaki
mesh_terms: D000368:Aged; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D005938:Glucocorticoids / Q000627:therapeutic use; D014890:Granulomatosis with Polyangiitis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D007958:Leukocyte Count; D008279:Magnetic Resonance Imaging; D008297:Male; D008581:Meningitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D008775:Methylprednisolone / Q000627:therapeutic use; D053146:Myeloblastin / Q000276:immunology; D009902:Optic Neuritis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D011239:Prednisolone / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D014792:Visual Acuity / Q000502:physiology
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D005938:Glucocorticoids; D002097:C-Reactive Protein; D011239:Prednisolone; D053146:Myeloblastin; D008775:Methylprednisolone