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PubMed1981

[Visual evoked potentials, contrast sensitivity and color perception in patients with optic nerve neuritis and multiple sclerosis].

Forty-nine patients with acute optic neuritis (in 21 cases associated with MS) and 26 patients known to have MS but with no history of optic nerve disease underwent visual evoked potential, contrast sensitivity and color vision tests. In patients with optic neuritis the contrast sensitivity was shown to detect optic nerve lesions better than the VEP an often permitted a distinction between acute and past optic neuritis. Combined testing with contrast sensitivity and VEP was superior to the single tests and detected 100% of the acute optic nerve lesions, although in many cases damage was selective and only involved some of the information channels. Desaturated color tests were abnormal in 3/4 of the patients, disturbances of blue-yellow discrimination being commoner than those of red-green. In cases with clinically unilateral optic neuritis the apparently normal partner eye was affected in 61% of the patients; complete recovery of optic nerve function without some residual deficit is rare. Approximately 3/4 of the eyes of patients known to have MS but with no history of past visual disturbances showed bilateral optic nerve involvement. The frequency of subclinical optic nerve lesions rose to 91% at a follow-up examination one year later. the literature is reviewed and our results are compared with the previously published data.

Adolescent↗
PubMed1985

Two common neuro-ophthalmic problems. Optic neuritis and transient visual disturbances.

Optic neuritis and transient visual disturbances are common and challenging neuro-ophthalmic problems. Optic neuritis may occur during the course of several neurologic and systemic disorders and is characterized by reversible central visual loss. In many patients, signs and symptoms of multiple sclerosis occur after an episode of optic neuritis. Although several risk factors for development of multiple sclerosis have been identified, the relationship between optic neuritis and multiple sclerosis is still controversial. Transient visual disturbances may take the form of visual loss or visual hallucinations. In many cases, the cause of transient visual loss is never found. Hallucinations of ocular origin, however, are easily diagnosed by a thorough eye examination.

Antibodies, Viral↗
PubMed1998

Optic neuritis. Doppler ultrasonography compared with MR and correlated with visual evoked potential assessments.

PURPOSE: To establish the role of Doppler ultrasonography (US) in the examination of patients with acute unilateral optic neuritis. MATERIAL AND METHODS: Twenty-five patients with a clinical diagnosis of optic neuritis were prospectively evaluated and 18 of them were included in the study. The inclusion criteria were MR findings of unilateral disease and age below 50 years. All patients were examined with MR in order to objectively detect, localize and measure the optic nerve lesions and in order to exclude patients with unidentifiable optic nerve involvement. Evaluation with US was performed to determine nerve morphology, nerve swelling, and resistance to flow in the central retinal artery. The patients' contralateral optic nerve served as an internal control. The US findings were correlated to the degree of visual impairment, both initially and at follow-up. Visual evoked potential (VEP) assessments were also performed in 16 patients. RESULTS: A statistically significant difference was found in the optic nerve diameter and in the resistance to flow in the central retinal artery between the affected and unaffected eyes. Patients with a prolonged impairment of visual acuity initially had a more swollen nerve and an increased resistance to flow in the affected optic nerve. Prognostic information was also gathered solely by evaluating the unaffected nerve diameter: patients who normally had thinner optic nerves had a more severe form of optic neuritis. VEP assessments were positive in all patients investigated. CONCLUSION: Doppler US can be used together with a VEP assessment as an indicator of the disease process in acute optic neuritis. These methods offer a potential for monitoring patients over time.

Adult↗
PubMed2003

Optic neuritis in adults and children.

Most ophthalmologists will encounter optic neuritis in the course of their practice. The disease behaves very differently in children versus adults. The ONTT and CHAMPS trials have given us important data regarding prognosis and management in adults, including probability of developing MS. Optic neuritis in children, while less common, must be considered in the differential diagnosis of subacute visual loss, especially in children with bilateral impairment. Secondary causes of optic neuritis are more common in children and an investigation should be performed to assess for associated disease states. In both populations, the ophthalmologist will play a central role in the diagnosis, treatment, and management of these patients, whether it is an isolated case of optic neuritis or the initial presentation of a long-term struggle with MS. With the advent of immunomodulating therapy to minimize both the subsequent incidence and severity of MS, early diagnosis and appropriate management by the ophthalmologist has become even more critical.

Adult↗
PubMed2006

Atopic optic neuritis.

PURPOSE: To report a case of optic neuritis associated with atopic dermatitis, which may represent an optic nerve counterpart of atopic myelitis. METHODS: Clinical examination, MRI, blood investigations. RESULTS: A 34-year-old man with severe atopic dermatitis developed a steroid-responsive bilateral optic neuritis. Serum IgE was highly elevated, with high titers of mite-specific IgE. Clinical ophthalmological fluctuations paralleled those of atopic dermatitis. CONCLUSIONS: The clinical features and parallel fluctuations strongly suggest that the patient's optic neuritis was related to atopic dermatitis. This atopic optic neuritis may represent the optic nerve equivalent of atopic myelitis.

Adult↗
PubMed2004

Ethambutol-induced optic neuritis in patients with end stage renal disease on hemodialysis: two case reports and literature review.

Ethambutol, a synthetic bacteriostatic agent, is a first line agent against Mycobacterium tuberculosis. Although optic neuritis is the most serious adverse effect of ethambutol, most cases in the literature are reversible. Renal failure prolongs the half-life of ethambutol and increases the risk of ethambutol-induced optic neuritis. We present two patients with end stage renal disease (ESRD), who were on maintenance dialysis and suffering ethambutol-induced optic neuritis. The first woman had been suffering ESRD on hemodialysis for 2 years. After tuberculosis was diagnosed, she was prescribed three-combined anti-tuberculosis medications, including ethambutol 800 mg/day. Bilateral blurred vision suddenly occurred 4 months after the start of treatment, and she became totally blind despite discontinuing ethambutol. The second woman had been on hemodialysis for 5 months. Tuberculosis was diagnosed by lung biopsy. After 3 weeks of three-combined anti-tuberculosis medications including ethambutol (1,200 mg/day), reduced visual acuity and color vision defects occurred. One year after the discontinuation of ethambutol, visual acuity remained little improved. Physicians should be aware of ethambutol-induced optic neuritis and ethambutol should be used cautiously in patients with renal failure.

Adult↗
PubMed1996

Retinal and cortical evoked responses to chromatic contrast stimuli. Specific losses in both eyes of patients with multiple sclerosis and unilateral optic neuritis.

It is known that colour vision may be altered in optic neuritis. Our aim was to establish whether chromatic and achromatic vision are differentially impaired using stimuli designed to favour the activity of either the magnocellular or the parvocellular stream of the visual pathway. Fourteen patients with a past history of unilateral optic neuritis in the course of multiple sclerosis and 10 age-matched control subjects were included in the study. Patients had relatively good visual acuity in the affected eyes and no gross colour deficits (Ishihara). Stimuli were alternating gratings of low spatial frequency and of different chromaticity along the red-green axis. The psychophysical contrast sensitivity (CS) was measured at 5 Hz as a function of colour ratio [red/(red + green)] to evaluate both the equiluminant point (the colour ratio corresponding to the lowest CS) and the CS for isochromatic, luminance gratings (red-black and green-black). Steady-state (2-24 Hz) and transient pattern electroretinograms (PERGs) and visually evoked potentials (VEPs) were recorded in response to high contrast (90%) stimuli of low spatial frequency (0.3 cycles deg-1) modulated in either pure chromatic contrast (equiluminant red-green) or pure luminance contrast (yellow-black). On average, CSs were reduced (10 dB) in optic neuritis eyes compared with controls for both luminance and chromatic gratings. In the VEPs (both transient and steady-state) amplitude losses and latency delays were far larger for the chromatic VEPs than for the luminance VEPs. Chromatic VEP latency delays were remarkable also in the fellow, clinically normal, eyes. Significant losses were apparent in both the luminance and chromatic PERG. However, the chromatic PERG was comparatively more altered. In agreement with previous reports, selective losses were not apparent at threshold. By contrast, suprathreshold electrophysiological responses displayed a clear dissociation between luminance and colour, suggesting that the parvocellular stream, compared with the magnocellular stream is more impaired in optic neuritis.

Adult↗
PubMed2001

Optic neuritis: historical aspects.

Optic nerve disorders were not reliably diagnosed until the late nineteenth century when ophthalmoscopy became part of the ophthalmic examination. By the early 1900's, all of the salient clinical features of optic neuritis and its relationship to "systemic sclerosis" were recognized, but there was much controversy and misunderstanding about its differential diagnosis, pathogenesis, and possible treatment. During the twentieth century, physicians began to distinguish optic neuritis from infectious, hereditary, toxic, nutritional, and ischemic optic neuropathies. The development of magnetic resonance imaging and the results from recent clinical trials have enhanced our understanding of the relationship between optic neuritis and multiple sclerosis. The next decade holds the promise of further elaborating the pathogenesis and treatment of optic neuritis.

History, 19th Century↗
PubMed1995

Optic neuritis and demyelination.

The Optic Neuritis Treatment Trial continues to generate information and controversy on the visual and neurologic outcome and treatment of optic neuritis. At the same time, other researchers explored cerebrospinal fluid parameters in multiple sclerosis, treatment of experimental optic neuritis, corticosteroid treatment of multiple sclerosis, and variations and mimickers of optic neuritis.

Demyelinating Diseases↗
PubMed1975

Virus antibody levels in serum specimens from patients with optic neuritis and from matched controls;.

Virus antibody levels in serum specimens taken in acute and convalescent phases from 77 patients with optic neuritits were tested by measles hamagglutination inhibition (HI), measles hemolysis inhibition (HLI), rubella HI, parainfluenza-1 HI, Epstein-Barr immunofluorescence (IF), and against 11 other viruses and mycoplasma pneumoniae with the complement fixation (CF) technique. The virus antibody levels were indicated to be usually very stable, and a fourfold change in virus antibody levels was demonstrated in only eight patients. The virus antibody levels were compared with specimens from two carefully selected control groups. The first control group consisted of 71 healthy persons matched in age, sex and place of residence with the patients with optic neuritis. The other control group consisted of 58 patients with various neurological diseases other than multiple sclerosis (MS) or infectious diseases of the central nervous system. The patients with optic neuritis had significantly higher measles antibody titres than the two control groups in both measles HI and measles HLI tests. Also in 33 patients with optic neuritis of unknown cause, the measles antibody levels were higher than in the control groups. On the other hand, various other antibody tests showed no statistically significant differences between patients with optic neuritis and the control group.

Acute Disease↗
PubMed2004

Use of corticosteroid sparing systemic immunosuppression for treatment of corticosteroid dependent optic neuritis not associated with demyelinating disease.

AIM: To describe the authors' experience and that in the published literature regarding the use of corticosteroid sparing systemic immunosuppression for patients with corticosteroid dependent optic neuritis not associated with demyelinating disease. METHODS: The records of 10 patients from the authors' clinical database, and 38 patients from the published literature with corticosteroid dependent optic neuritis, were retrospectively reviewed to determine patient demographics, diagnosis, clinical course, and outcomes. These patients had recrudescence of symptoms, such as decreased vision and pain, with attempted taper of corticosteroid. Many of these patients also suffered side effects from systemic corticosteroid use such as weight gain and uncontrolled hyperglycaemia. Antimetabolites (for example, methotrexate and azathioprine), cyclosporine and/or alkylating agents (for example, cyclophosphamide and chlorambucil) were given to enable taper of corticosteroid while effectively controlling optic neuritis. RESULTS: The study included 43 women and 5 men: 17 patients with systemic lupus erythematosus, 12 patients with sarcoidosis, 3 with other systemic autoimmune diseases, and 16 with no clinically identifiable systemic association. 79% of all patients benefited from the use of systemic immunosuppression in that they had successful corticosteroid taper, control of inflammation, improvement in symptoms, and/or tolerance of adverse effects. Mild toxicity was common and 19% of patients, most often those taking cyclophosphamide, discontinued medication because of adverse effects. 24 of 28 (86%) patients on alkylators benefited clinically, while 20 of 29 (69%) patients on antimetabolites had clinical benefit. CONCLUSION: Systemic immunosuppression may be a safer and more effective treatment alternative to chronic oral corticosteroid use in cases of corticosteroid dependent optic neuritis not associated with demyelinating disease.

Adrenal Cortex Hormones↗
PubMed1984

Contrast sensitivity measurements in acute and resolved optic neuritis.

We measured contrast sensitivity by means of Arden grating plates in 41 eyes with acute optic neuritis and in 51 eyes with resolved optic neuritis. The scores were abnormal in 93% of eyes in the acute phase and 78% in the resolved phase irrespective of visual acuity. Even when acuity improved to 6/7.5 or better with resolution of the neuritis, 67% of eyes still showed abnormal contrast sensitivity. Since Snellen acuity represents just one point at the high spatial frequency end of the contrast sensitivity function, a patient in whom acuity improves to 6/6 with resolution of optic neuritis may still have difficulty seeing objects of lower relative contrast or at lower spatial frequencies.

Acute Disease↗
PubMed1988

Recovery after optic neuritis in childhood.

Thirty-nine children who presented with optic neuritis in childhood were reviewed after a follow up period from 3 months to 29 years (mean 8.8 years). At follow-up, 30 out of 39 (77%) of the children had had no further episodes and in three (8%) there was recurrence of optic neuritis alone. Multiple sclerosis had developed in six patients (15%), a much lower frequency than after optic neuritis in adult life. Regardless of the initial degree of visual impairment or neurological outcome, the visual prognosis was excellent. Pattern evoked potentials at follow-up were much more frequently normal (55%) than in adults (10%) after optic neuritis.

Adolescent↗
PubMed2002

Evaluation of the management of optic neuritis: audit on the neurological and ophthalmological practice in the north west of England.

The management of acute optic neuritis by neurologists and ophthalmologists in the north west of England was assessed in the light of the Optic Neuritis Treatment Trial (ONTT) recommendations. A questionnaire on a fictitious case of typical unilateral optic neuritis was mailed to all consultant ophthalmologists and neurologists working in the North West and Merseyside Health Authorities. They were then asked to comment on management of the case. Fifty two out of 86 ophthalmologists and 20 out of 28 neurologists replied. The overall response rate was 63%. Sixty five per cent of neurologists and 46% of ophthalmologists would investigate a typical case of acute optic neuritis further. Forty six per cent of neurologists and 36% of ophthalmologists were likely to arrange MRI of the brain or orbit. Significantly more neurologists (55%) than ophthalmologists (9%) chose to treat with intravenous methylprednisolone (p<0.005). Significantly more ophthalmologists (64%) than neurologists (32%) chose not to give steroids (p<0.025). Oral prednisolone alone was rarely selected for treatment. Respondents were more likely to discuss multiple sclerosis with the referring doctor than with the patient. Only 32% of ophthalmologists and 20% of neurologists would clearly mention the possibility of improvement to the patient. Clear differences in practice between ophthalmologists and neurologists remain. A consensus on practice guidelines on the issues raised might be useful.

Acute Disease↗
PubMed2003

Optic neuritis: evaluation with orbital Doppler sonography.

PURPOSE: To evaluate orbital blood flow velocities with Doppler sonography in patients with acute unilateral optic neuritis. MATERIALS AND METHODS: Orbital Doppler sonography was performed in 20 patients with acute unilateral optic neuritis. Optic neuritis was diagnosed by a neurologist on the basis of clinical presentation, presence of decreased visual acuity, and assessment of visual evoked potentials. The peak systolic and end diastolic velocities and the resistive index were measured in the ophthalmic and central retinal arteries of both orbits. The values obtained from affected and unaffected orbits were compared by using the paired t test. RESULTS: The peak systolic and end diastolic velocities in the ophthalmic artery were significantly increased in the affected orbits (for peak systolic velocity P <.001, for end diastolic velocity P <.05). Resistive indexes in the ophthalmic arteries did not differ (P >.05). The difference between the peak systolic and end diastolic velocities and resistive indexes in the central retinal arteries of affected and normal eyes was not statistically significant (P >.05). CONCLUSION: Peak systolic and end diastolic velocities in the ophthalmic artery are increased in patients with acute optic neuritis.

Acute Disease↗
PubMed1998

Optic neuritis: MR imaging with combined fat- and water-suppression techniques.

PURPOSE: To examine the benefits of combined fat- and water-suppressed T2-weighted magnetic resonance (MR) images in the diagnosis of optic neuritis. MATERIALS AND METHODS: MR imaging was performed with a 1.5-T unit in five healthy volunteers and 18 patients (21 nerves). All patients had abnormalities of visual evoked potentials and fulfilled the clinical criteria for the diagnosis of optic neuritis. Imaging was performed within 4 weeks of diagnosis (n = 12) or between 3 and 6 months after diagnosis (n = 6). Coronal images were obtained throughout the course of the optic nerve with use of three sequences: (a) short inversion time inversion recovery with fast spin-echo (SE) acquisition, (b) selective partial inversion-recovery (SPIR) prepared T2-weighted fast SE acquisition, and (c) SPIR-fluid-attenuated inversion recovery (FLAIR) with fast SE acquisition. RESULTS: Neuritic segments were demonstrated in all 21 symptomatic nerves. The extent of neuritic involvement (number of images showing abnormality) was significantly greater with the SPIR-FLAIR sequence (P < .01). The contrast ratio between neuritic optic nerve and orbital fat, normal nerve, and cerebral spinal fluid was significantly greater with SPIR-FLAIR than with the other sequences (P < .001). SPIR-FLAIR images also improved demonstration of optic nerve atrophy in chronic neuritis when compared with the other sequences. CONCLUSION: The SPIR-FLAIR sequence offers important advantages over current methods in the demonstration of optic neuritis.

Adult↗
PubMed1985

Anti-myelin basic protein antibody in experimental allergic optic neuritis and encephalomyelitis.

We produced demyelinating optic neuritis and encephalomyelitis in juvenile strain 13 guinea pigs by sensitization with optic nerve myelin. Three distinct clinical courses were noted: a severe, acute optic neuritis associated with a rapidly fatal encephalomyelitis; a mild, chronic optic neuritis with a nonfatal encephalomyelitis; and an initially mild disease followed by an acute exacerbation of optic neuritis and fatal encephalomyelitis. Clinically mild disease was associated with elevated levels of anti-myelin basic protein antibody, while severe disease was associated with extremely low antibody levels.

Animals↗
PubMed1975

[Does a correlation exist between Myambutol dosage and occurrence of optic neuritis].

The frequency of retrobulbar neuritis during a long lasting myambutol therapy increases proportionally with the increased doses. This may be seen in retrospection on 2007 cases divided into 16 groups with doses from 15 till 60 mg per kg of bodyweight. Graphically a function may be established between myambutol doses and frequency of optic neuritis (y = -23.2 + 1.1 x). This shows for 20 mg/kg: 0%, for 25 mg/kg: 5%, for 30 mg/kg: 10% frequency of optic neuritis. Those findings allow a rough evaluation of neuritis risk and confirm clinical observations. A planed examination of patients groups with different myambutol doses checked by myambutol serum levels estimations would help in establishing optimal doses of myambutol.

Dose-Response Relationship, Drug↗