Optic Neuropathy Secondary to Cat Scratch Disease: Distinguishing MR Imaging Features from Other Types of Optic Neuropathies
Ilona M. Schmalfussa,b,
Cooper W. Deana,
Chris Sistroma and
M. Tariq Bhattic,d,e
a Department of Radiology, University of Florida College of Medicine, Gainesville, FL 32610-0284
b Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL 32610-0284
c Department of Ophthalmology, University of Florida College of Medicine, Gainesville, FL 32610-0284
d Department of Neurology, University of Florida College of Medicine, Gainesville, FL 32610-0284
e Department of Neurosurgery, University of Florida College of Medicine, Gainesville, FL 32610-0284
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FIG 1. The fundoscopic photograph shows the characteristic macular star formation composed of very small bright spots (arrows) to the right of optic nerve disk and aligned in a stellar configuration.
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FIG 2. 20-year-old woman with most extensive imaging findings of optic neuropathy due to cat scratch fever (patient 3, Table 2).
A and B, Axial (A) and coronal (B) gadolinium-enhanced fat-suppressed T1-weighted images (TR1, TR2/TE, 735, 850/14) show significant bulging of the right optic disk (arrow, A) associated with severe enhancement at the optic nerve–globe junction (arrow, A and B). Note the normal appearance of the optic nerve–globe junction on the left (arrowhead, A and B).
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FIG 3. 17-year-old girl with moderate imaging findings of optic neuropathy due to cat scratch fever (patient 4, Table 2).
A and B, Axial (A) and coronal (B) gadolinium-enhanced fat-suppressed T1-weighted images (TR1, TR2/TE, 735, 875/14) show bulging of the left optic disc (arrow, A) that is markedly less pronounced than that on the right (arrowhead, A) as well as that in Figure 1. The associated enhancement at the left optic nerve–globe junction (arrow, A and B) is also markedly less extensive. Note the normal appearance of the optic nerve–globe junction region on the right (arrowhead, A and B).
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FIG 4. 42-year-old woman with very subtle imaging findings of optic neuropathy due to cat scratch fever (patient 5, Table 2).
A and B, Axial (A) and coronal (B) gadolinium-enhanced fat-suppressed T1-weighted images (TR1, TR2/TE, 735, 882/14) show very minimal bulging of the left optic disk (arrow, A) compared with those in Figures 1 and 2. The associated enhancement at the left optic nerve–globe junction (arrow, A and B) is very subtle, in particular in the coronal plane. Note the normal appearance of the optic nerve–globe junction region on the right (arrowhead, A and B).
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FIG 5. Plot of enhancement in 44 optic nerves (37 patients). Each horizontal line represents the area of enhancement in a single nerve. The distance from zero on the x-axis to the left end of the line represents length (if any) of nonenhancing nerve adjacent to the globe. The length of the line itself represents the extent of enhancement. The 5 enhancing nerves in patients with optic neuropathy due to cat scratch disease are at the bottom (bold lines). The other 39 enhancing nerves with optic neuropathy from other causes are above these (thin lines). The one patient with false-positive findings is marked as a short thin line just above the patients with cat scratch disease.
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