Significant decline in vision OD, concern for compressive/ischemic optic neuropathy OD: afferent pupillary defect and loss of color OD. Orbits: The bilateral globes, optic nerves, and ocular adnexa are unremarkable. There is no evidence of abnormal intraorbital enhancement or mass lesions.Brain: There is high T2 signal and enhancement of the optic chiasm and prechiasmatic optic nerves, right more than left, with minimal swelling. There are a few punctate foci of non-enhancing white matter T2 hyperintensity in the bilateral frontal lobes. Otherwise, there is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain, cerebellum, brainstem, and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. There are left maxillary ans sphenoid sinus retention cysts.
Enhancement of the optic chiasm and prechiasmatic optic nerves, right more than left is compatible optic neuritis and a few nonspecific punctate white matter lesion in the unilateral frontal lobes. An autoimmune demyelinating process is a possible etiology, but other considerations include a subacute ischemic event or toxic-metabolic exposure, or perhaps even a neoplastic process, such as lymphoma.