Bilateral concentric visual field defect as an initial manifestation of multiple sclerosis

The lesions in multiple sclerosis have been found in radiological examinations without associated clinical manifestations. However, the symptomatic visual field defects in MS free from optic neuritis is unusual. We report a case with a bilateral concentric visual field defects as the initial manifestation of multiple sclerosis.

Poster 16 Bilateral concentric visual field defect as an initial manifestation of multiple sclerosis sungeun Kyung1, Junsoo Eun1, Kyungyoon Shin1, Moohwan Chang1 Dankook University, Cheonan, Korea, Republic of 1 Introduction: The lesions in multiple sclerosis have been found in radiological examinations without associated clinical manifestations. However, the symptomatic visual field defects in MS free from optic neuritis is unusual. We report a case with a bilateral concentric visual field defects as the initial manifestation of multiple sclerosis. Methods: A 22 year-old male without history of optic neuritis suffering from slowly progressing bilateral concentric visual field defects with duration of 1 year presented to our clinic. His best-corrected visual acuity, intraocular pressures, and anterior segment examination findings were normal bilaterally. Fundus examination showed pale optic disc in both eyes. Humphrey Field Analyzer revealed a bilateral concentric visual field defect. Results: The optical coherence tomography (OCT) showed thinning of peripapillary retinal nerve fiber layer (RNFL) and decreased macular volume. The mitochondrial DNA (mtDNA) analysis in the diagnosis of Leber hereditary optic neuropathy (LHON) was negative. The brain magnetic resonance imaging (MRI) showed multifocal bilateral asymmetric T2 hyperintense lesions in left frontal lobe subcortical area, left cingulate gyrus and both frontal lobe subcortical and deep white matter. The diagnosis of probable MS was made. Conclusions: Multiple sclerosis is an autoimmune demyelinating disorder of the nervous system. Optic neuritis, the most common ocular manifestation of multiple sclerosis, may be the initial clinical disease manifestation. However, there is a possibility of slowly progressing concentric visual field defect could be a initial signs of multiple sclerosis in a patient without any history of optic neuritis. References: 1. Jacobs L, Kinkel WR, Polachini I, Kinkel PR. Correlations of nuclear magnetic resonance imaging, computerized tomography, and clinical profiles in multiple sclerosis. Neurology 1986; 36: 27-34. 2. Chen L, Gordon LK, Ocular manifestations of multiple sclerosis. Curr Opin Ophthalmol.2005 ;16:315-20. 3. B Sanchez-Dalmau, F J Goñi, M Guarro, C Roig, F Duch-Bordas, Bilateral homonymous visual field defects as initial manifestation of multiple sclerosis. Br J Ophthalmol 1991 ;75: 185-187 Keywords: Neuro-ophth & systyemic disease ( eg. MS, MG, thyroid), Demeylinating disease, Optic neuropathy, Neuroimaging, Visual fields Financial Disclosures: The authors had no disclosures. Grant Support: None. 2017 Annual Meeting Syllabus | 71