2025 American Academy of Neurology Abstract Website

Objective:

We report a rare case of non-arteritic anterior ischemic optic neuropathy (NAION) in a healthy 32-year-old Caucasian female, who experienced acute, painless vision loss at 34 weeks of gestation.

Background:

NAION typically occurs in older individuals with vascular risk factors. While NAION has been reported in the setting of post-partum complications of hemorrhage or severe pre-eclampsia, cases of NAION in uncomplicated pregnancy are rare.

Our patient experienced a four-day history of painless peripheral vision loss in her right eye. Her medical history was unremarkable, and her pregnancy was uncomplicated. Examination showed 20/20 visual acuity, normal color vision, and extraocular movements bilaterally. However, the right eye exhibited a relative afferent pupillary defect, an inferior altitudinal field defect, and 2-3+ optic nerve edema.

Design/Methods:

N/A

Results:

Comprehensive investigations were conducted to evaluate for demyelinating/ inflammatory and infectious conditions. A non-contrast MRI of the brain and orbits showed questionable T2 prolongation in the right optic nerve without other abnormalities. A five-day course of IV Solumedrol 1000 mg was administered for the vision loss, but symptoms remained constant. A lumbar puncture performed for intermittent headaches and otherwise static symptoms revealed normal opening pressure (21 cm of H2O).

At labor induction five days post-admission, the patient had two systolic blood pressure readings of 150, indicating pre-eclampsia. She underwent an uncomplicated cesarean section. Follow-up MR imaging of the brain, and orbits with contrast showed no abnormal enhancement, and she was discharged with stable symptoms.

Conclusions:

At two- and six-week follow-ups, her vision remained 20/20, although the inferior visual field defect persisted. Given the negative work-up for other etiologies and features most consistent with NAION, a diagnosis of NAION secondary to pre-eclampsia was established. In contrast to existing literature, our patient had NAION precede hypertension, leading us to conclude that such a presentation should prompt evaluation for pre-eclampsia for early intervention.