Optic Neuritis

32-year-old female presented with acute onset right eye pain with movement and vision loss. The images demonstrate enlargement of the orbital segment of the optic nerve with central T2 hyperintense signal approaching the orbital apex and bilateral optic sheath effusions. On the postcontrast images, there is central wispy enhancement within the optic nerve itself extending to the level of the optic disc. Findings are compatible with acute onset optic neuritis. Optic neuritis can be divided into infectious and noninfectious categories with noninfectious causes much more common. The typical patient has a history of multiple sclerosis with disease affecting predominately young adults and a female to male ratio of 3 to 1. Clinical symptoms include pain in the orbit, worsened with eye movement, and associated with visual loss. Noninfectious causes of optic neuritis, along with multiple sclerosis, include neural myelitis optic, sarcoidosis, acute disseminated encephalomyelitis, collagen vascular diseases, and radiation induced cause. Infectious etiologies include Lyme disease, toxoplasmosis, human immunodeficiency virus, and varicella or herpes. Corticosteroid use may shorten recovery time with possible improvement in visual function long term.