Bilateral cavernous degeneration of the optic nerve associated with multiple arteriosclerotic ischemic infarctions.

Abstract

The association of cavernous degeneration of the optic nerve with acute glaucoma was first noted by Schnabel [9]. Cavernous degeneration may also occur as a result of ischemia in the nutrient vessels. Ischemic infarction of the optic nerve resulting in cavernous optic nerve atrophy has been observed in various diseases, such as giant-cell arteritis [6], arteriosclerosis [4, 11] and embolism [1, 3]. These entities were reported to be underlying diseases of cavernous degeneration of the optic nerve with deposition of hyaluronic acid. This study demonstrates bilateral non-glaucomatous cavernous optic nerve atrophy in a 84-year old female with marked ischemic infarctions. A 84-year-old woman was found unconscious on January 28, 1991, and transferred to the Department of Neurology, University of Erlangen-Nfirnberg, with a diagnosis of "apoplexy." The clinical diagnosis was left arteriosclerotic cerebral infarction, absolute arrythmia, and cor pulmonale. On August 3, 1988, corrected visual acuity had been 35/50 in the right eye (with + 1.5D+ 1.25D axis 180 °) and light perception in the left eye. Ophthalmologic examination revealed a cataract in both eyes and ischemic optic nerve atrophy in the left eye. The intraocular pressure was within normal limits. The patient's past medical history included cardiac insufficiency and nephrectomy 10 years ago. Neurological examination revealed a weakness of the right corneal reflex, right facial paresis, and global aphasia. Physical examination showed absolute arrythmia, cardiac insufficiency, and pretibial edema. No ultrasonographic evidence of a stenosis in the carotid arteries was present. The patient showed psychomotoric excitation.