Article Figures & Data
Figures
- Fig 1.
Images from 1988 obtained in a patient with AIDS with CMV-induced ARN preceding retrobulbar optic neuritis.
A, CT scan shows a shrunken left globe with bilateral avidly enhancing sclera (arrowheads) and enhancement of both optic nerves (arrows).
B, T2-weighted image shows increased signal intensity in the optic tracts (top arrows) and geniculate bodies (bottom arrows).
- Fig 2.
MR images obtained in patient 2.
A, T2-weighted coronal image shows both increased (left) and decreased (right) signal in the optic tracks (arrows).
B, Contrast-enhanced T1-weighted image shows enhancement of the left optic nerve and low signal intensity in the right optic nerve (arrows).
C and D, Contrast-enhanced T1-weighted images show enhancement of the right optic tract (arrow in C) and chiasm (arrowhead in D).
- Fig 3.
Images obtained in patient 3 with HZV-induced progressive outer retinal necrosis preceding retrobulbar optic neuritis, CNS extension, and eventual demise.
A, Coronal T2-weighted gradient-echo image suggests hemorrhage in the right lateral geniculate body, with increased signal intensity involving the optic radiation through the temporal lobe (arrowhead) and extending caudad along the lateral midbrain (large arrow) to the cerebellum (small arrow).
B, Axial T2-weighted turbo spin-echo image shows increased signal intensity along the right optic tract (white arrow) and lateral geniculate body (black arrow).
C and D, Proton density–weighted images demonstrate abnormally high signal intensity along the right hemipons (thin arrow in C), right midbrain, and superior colliculus (arrow in D), occipital (visual) cortex (thick arrow in C), and optic radiation in the temporal lobe (arrowheads in D).
E, T1-weighted contrast-enhanced image shows enhancement in similar regions: optic tract (white arrow) and lateral geniculate body (black arrow). Postmortem immunofluorescence stains (not shown) demonstrated HZV in these areas.
- Fig 4.
Patient 4 with HZV-induced progressive outer retinal necrosis and retrobulbar optic neuritis after herpes ophthalmicus. T1-weighted contrast-enhanced image shows enhancement of the optic nerves (right distal, left proximal) and optic chiasm (arrows). Compare the thickened, avidly enhancing right chorioretina with the normally enhancing left retina (arrowheads).
- Fig 5.
Axial images obtained in elderly HIV-negative woman with HZV ophthalmicus preceding retrobulbar optic neuritis and mental status changes.
A and B, Nonenhanced and enhanced T2-weighted FLAIR images at the level of the pons show minimal abnormal high signal intensity in A and avid enhancement in B in the left ambient cistern, supracerebellar cistern, cerebellar vermis and adjacent subarachnoid space along the tentorium (arrowheads).
C–E, Axial images at the level of the midbrain. Contrast-enhanced conventional T1-weighted image in C shows minimal enhancement. Nonenhanced (D) and enhanced (E) T2-weighted FLAIR images show avid enhancement of the optic nerves, chiasm, tracts, and pericavernous region (black arrowheads), right lateral geniculate body (white arrowhead), interpeduncular cistern (black arrow), and supracerebellar cistern (white arrow).
Tables
Patient HIV Status CD4 Count (%) WBC Count (k/μl) Retinal Diagnosis Onset Vision Lumbar Puncture ARN RBON-H or CNS Infection OD OS 1 Positive Normal* Low† CMV ARN, OS>OD Feb–Mar 1988 July 1988 Decreased to blind Moderately to severely decreased NO 2 Positive 12 Low† CMV ARN, OU Mar 1994 Mar 1994 Severely decreased Severely decreased NO 3 Positive 5–80 Low† HZV progressive ORN, OS>>OD Nov 1994 Mar 1995 20/300 20/20, later decreased Normal 4 Positive 30 2.2 HZV progressive ORN, OD>>OS Aug 1998 Aug 1998 Blind 20/60 NO 5 Positive 3–44 11 HZV progressive ORN, CMV OS Mar, Aug 1998 Mar 1998 Blind 24/100 Normal 6 Negative Normal 4.6 Normal Normal Sept 1929 Iritis, decreased Iritis, decreased HZV, positive WBC count‡ increased Note.—OD indicates oculus dexter (right eye); ORN, outer retinal necrosis; OS, oculus sinister (left eye); NO, not obtained.
* T4/T8 ratio of 126/16, used for prognosis prior to the establishment of CD4 subtypes.
† WBC count was recorded only as “below normal” in the obtainable records.
‡ Lumbar puncture was traumatic, and samples grew skin contaminants after 3 days.
- TABLE 2:
CT and MR imaging findings in six patients with Herpesviridae infection and ARN and/or RBON-H
Patient Optic Nerve Optic Chiasm Optic Tract Lateral Geniculate Optic Radiation Visual Cortex 1* ↑T1, ↑T2, CECT ↑T1, ↑T2 ↑T2 ↑T2 ↑T2 2 ↓T1, T1E, ↑T2, HDCT T1E, ↑T2 ↑T2, ↓T2GE, HDCT ↑T2, ↓T2GE, HDCT ↓T2 3† CECT T1E, ↑T2, ↓T2GE T1E, ↑T2, ↓T2GE, CECT T1E, ↑T2, CECT T1E, ↑T2 4 T1E, ↑T2 T1E, ↑T2 T1E, ↑T2 T1E, ↑T2 ↑T2 5* T1E, ↑T2 T1E, ↑T2 T1E, ↑T2 T1E, ↑T2 ↑T2 6§ T1E, ↑T2 T1E, ↑T2 T1E, ↑T2 T2FE T2FE Note.—CECT indicates enhancement on contrast-enhanced CT images; HDCT, high attenuation (increased relative to gray matter) on nonenhanced CT images; T1E, enhancement on contrast-enhanced T1-weighted MR images, ↑T1, increased signal intensity on T1-weighted MR images; T2FE, enhancement on T2 FLAIR sequence; ↑T2, increased signal intensity on T2-weighted MR images; and ↓T2GE, decreased signal on gradient-echo T2-weighted images.
* Other findings included phthisis bulbi.
† Other findings included T1E in the midbrain, superior cerebellar peduncle, temporal lobe and ↑T2 in the thalamus, midbrain, pons, and cerebellum.
‡ Other findings included T1E in the midbrain and temporal lobe.
§ Other findings included T1E in the meninges, cerebellum, midbrain, Meckel cave and ↑T2 and T2FE in the meninges, cerebellum, midbrain, and Meckel cave.
