Diffusion MRI and tensor tractography in ischemic optic neuropathy

Ischemic optic neuropathies (IONs) are among the most prevalent diseases causing visual impairment in middle-aged and elderly people. While arteritic ION is an ocular emergency and requires early diagnosis and immediate treatment with systemic high-dose corticosteroids to prevent further visual loss, treatment options for non-arteritic ION remain limited. We describe the case of a woman with unilateral right-sided non-arteritic posterior ischemic optic neuropathy. The diagnosis was made on clinical and radiographic grounds. Diffusion-weighted sequences and apparent diffusion coefficient maps revealed markedly restricted diffusion in the right optic nerve. It was very helpful to precise the posterior topography of the optic nerve lesion. Furthermore, we reported the diffusion tensor tractography study which appears to be an objective tool to assess the incomplete visual recovery. These MRI techniques including tensor tractography remain to be evaluated in large cohort of ION patients’ particularly in future therapeutic trials.