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hospitalisation, several imaging and laboratory tests (complete blood count, immunoserology)
were performed. Fluorescence angiography (FLAG) showed increased late papillary staining,
contrast-enhanced cranial MRI showed normal pressure hydrocephalus, moderate
microvascular damage and optic neuritis. CFF, visual field, superficial temporal artery biopsy
and VEP were also performed, but these did not lead to a definite diagnosis, so high-dose
steroid therapy was started on an empirical basis during the first days. The results of the
immuno-serologic examination showed anti-aquaporin-4 (AQP4) positivity, which is
characteristic of neuoromyelitis optica. After the exact diagnosis was established, the patient
underwent multiple plasmapheresis, after which her vision partially returned. The patient was
then treated with immunosuppressive azathioprine, but this was discontinued due to side
effects. A parenteral satralizumab treatment with a more favourable side effect profile is
currently being licensed and funded on an individual equity basis.

Conclusion: Sudden visual loss can often be caused by different neuroophthalmological
pathologies (multiple sclerosis, AION, NMO), and the accurate differential diagnosis is crucial.
Early diagnosis can help to select the appropriate therapeutic modality and thus slow down
the progression of the disease.