Background <p>Optic neuritis is primarily an inflammatory demyelinating disorder of the optic nerve; however, emerging evidence suggests that vascular hypoperfusion may also contribute to visual pathway involvement. Brain CT perfusion provides functional assessment of cerebral hemodynamics and may detect perfusion abnormalities not visible on conventional imaging. The aim of this study was to explore the potential role of brain CT perfusion in different types of optic neuritis.</p> Case presentation <p>We report a descriptive four-case series of optic neuritis with different etiologies, including chemotherapy-related inflammation, ischemic optic neuropathy, HIV/syphilis-related optic neuritis and typical inflammatory optic neuritis. All patients underwent brain CT perfusion imaging. Perfusion abnormalities involving the occipital cortex and splenium were observed, as reflected by alterations in cerebral blood flow, cerebral blood volume, mean transit time, Tmax and exploratory parameters such as potential recuperation ratio and mismatch ratio.</p> Conclusions <p>Brain CT perfusion may provide complementary functional information regarding visual pathway involvement in optic neuritis. The observed perfusion alterations should be interpreted as exploratory and hypothesis-generating<b>,</b> and further studies are required to clarify their clinical and prognostic significance.</p>