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PubMed1986

The 'flicker test' according to Aulhorn in the diagnosis of acute optic neuritis.

The flicker test, introduced by Aulhorn is a new simple method to detect acute optic neuritis. We examined 24 patients suffering from acute optic neuritis. 23 patients showed a pathological result. In 179 subjects (patients with other ophthalmological diseases and healthy persons) the flicker test always showed normal results. After restitution of acute optic neuritis the results of the flicker test return to normal while the visual evoked responses remain pathological in many cases. Thus the flicker test can be an efficient tool in the diagnosis and differential diagnosis of acute optic neuritis.

Acute Disease↗

PubMed2004

Intravenous immunoglobulin and interferon: successful treatment of optic neuritis in pediatric multiple sclerosis.

Optic neuritis is a common clinical condition that causes loss of vision. It can be clinically isolated or can occur as one of the manifestations of multiple sclerosis. Multiple sclerosis is a severe disabling demyelinating disease of the central nervous system, which is rare among children. The treatment of optic neuritis has been investigated in several trials, the results of which have shown that corticosteroids speed up the recovery of vision without affecting the final visual outcome. Treatment of neurologic disorders with intravenous immunoglobulin is an increasing feature of our practice for an expanding range of indications, including multiple sclerosis. Owing to its anti-inflammatory properties, intravenous immunoglobulin can be beneficial in the treatment of acute relapses and in the prevention of new relapses of multiple sclerosis. To our knowledge, there is only one experience of treatment of optic neuritis with intravenous immunoglobulin in multiple sclerosis, even if therapeutic trials are used in the therapy of multiple sclerosis. We report on a girl with optic neuritis and multiple sclerosis in whom treatment with intravenous immunoglobulin at first alone and subsequently associated with interferon achieved great improvement in visual acuity.

Adjuvants, Immunologic↗

PubMed2002

Continuing optic nerve atrophy following optic neuritis: a serial MRI study.

To investigate optic neuritis as a model for atrophy in multiple sclerosis (MS) lesions we performed serial magnetic resonance imaging (MRI) on 10 patients with a history of optic neuritis using a fat saturated short-echo fast fluid-attenuated inversion recovery (sTE fFLAIR) sequence. The first study was performed a median of 19.5 months after the onset of optic neuritis and the second 1 year later. Using a computer-assisted contouring technique, a blinded observer calculated the mean area of the intro-orbital optic nerves. The mean area of affected optic nerves decreased over 1 year by 0.9 mm2 from 11.1 to 10.2 mm2 (p = 0.01). Poor visual acuity and decreased visual-evoked potential (VEP) amplitude were associated with atrophy. These findings suggest that atrophy is a feature of focal demyelinating lesions, it may evolve over several years, and may have functional significance. Optic neuritis provides a model to study the effect of inflammatory demyelination through the ability to accurately measure visual function and to visualize and measure the optic nerves using magnetic resonance imaging.

Adult↗

PubMed2001

The clinical profile of childhood optic neuritis.

PURPOSE: To report the clinical features and outcome of a series of children with optic neuritis. METHODS: We reviewed the medical records of patients up to 16 years old with optic neuritis. Group 1 comprised children seen up to two weeks after the onset of visual loss; Group 2 comprised patients already harboring optic atrophy. RESULTS: There were 15 boys and 12 girls. The mean age was 10.9 years. Bilateral optic neuritis occurred in 10. Optic disc pallor was found in 35%, edema in 46%, and 19% had normal fundus. During follow-up visual acuity improved in all but one eye in Group 1, and in six of seven eyes in children in Group 2. Just one child converted to multiple sclerosis. CONCLUSIONS: This study shows that the clinical features of childhood optic neuritis differ from those observed in adults. In children it has a better visual outcome and a lower conversion rate to multiple sclerosis than in adults.

Adolescent↗

PubMed2006

[Optic neuritis after meningococcal vaccination].

CASE REPORT: We report the case of a 13 year-old male with bilateral optic neuritis after meningococcal C vaccination. He was treated with intravenous corticosteroids, but only showed visual recovery in one eye. A significant limitation of his sharp vision remained in his other eye. DISCUSSION: There have been no previously reported cases of optic neuritis after meningococcal C vaccination and for this reason we have reported this case. It is not possible, however, to exclude some other factor in the etiology of the optic neuritis, but the temporal relationship between the neuritis and the vaccination suggests this was the cause.

Adolescent↗

PubMedDate not supplied

Saphenous neuritis: a poorly understood cause of medial knee pain.

Saphenous neuritis is a painful condition caused by either irritation or compression at the adductor canal or elsewhere along the course of the saphenous nerve. The condition also may be associated with surgical or nonsurgical trauma to the nerve, especially at the medial or anterior aspect of the knee. Saphenous neuritis can imitate other pathology around the knee, particularly a medial meniscal tear or osteoarthritis. Unrecognized saphenous neuritis can confuse the patient's clinical picture, complicate treatment, and compromise results. As an isolated entity, saphenous neuritis may appear in conjunction with other common problems, such as osteoarthritis and patellofemoral pain syndrome, and it can have an indolent and protracted course. Its clinical appearance is characterized by allodynia along the course of the saphenous nerve. The diagnosis is confirmed by relief of symptoms after injection of the affected area with local anesthetic. Initial treatment can include non-surgical symptomatic care, treatment of associated pathology, and diagnostic or therapeutic injections of local anesthetic. In recalcitrant cases, surgical decompression and neurectomy are potential options. The key to treatment is prompt recognition; palpation of the saphenous nerve should be part of every routine examination of the knee.

Decompression, Surgical↗

PubMed1999

[Effect of vaccination programs on the incidence of idiopathic optic neuritis].

UNLABELLED: To evaluate the influence of vaccination programs on the incidence of idiopathic optic neuritis. MATERIAL: 359 questionnaired patients with idiopathic optic neuritis hospitalized in the Department of Ophthalmology in Bydgoszcz and in the province of Bydgoszcz in the period from 1978 to 1997. Control group included 264 persons with no history of optic neuritis. RESULTS: Vaccinated persons were significantly (p = 0.01) rarely affected by this disease. CONCLUSION: The study revealed the positive correlation between lack of vaccination (according to vaccination program) and the incidence of idiopathic optic neuritis.

Catchment Area, Health↗

PubMedDate not supplied

Optic neuritis in children.

PURPOSE: To describe the clinical characteristics of optic neuritis in children, including final visual acuity and development of multiple sclerosis (MS). METHODS: Charts were reviewed of all patients < 15 years of age who presented with optic neuritis to the Bascom Palmer Eye Institute or the Miami Children's Hospital between 1986 and 1998. RESULTS: Fifteen patients were identified. There was a slight female predilection in the study group (60%), with a mean age of 9.8 years at presentation. A preceding febrile illness within 2 weeks of visual symptoms was reported in 66% of patients. Initial visual acuity ranged from 20/15 to no light perception. Involvement was bilateral in 66% of patients, and disc swelling was present in 64% of involved eyes. Of the patients who underwent magnetic resonance imaging, 33% had focal demyelinating lesions in the brain, and 63% of affected nerves were enlarged or enhanced with gadolinium. Eleven patients were treated with intravenous steroids. Final visual acuity was > or = 20/40 in 58.3% of eyes. Thirty percent of the patients had vision of finger counting or worse. Four (26%) patients developed MS. The mean age of patients with MS was 12 years, compared with 9 years in children who did not develop MS. Patients with unilateral involvement had an excellent visual prognosis (100% > 20/40), but a higher rate of development of MS (75%). Two patients had positive serology for Lyme disease. CONCLUSIONS: Optic neuritis presents differently in children than in adults. Children typically have bilateral involvement with papillitis following an antecedent viral illness. Although visual prognosis is poorer in children than adults, the development of MS is less common in children. Children who present with unilateral involvement have a better visual prognosis; however, they also develop MS at a greater frequency than children with bilateral involvement. Patients who developed MS were, on average, older at presentation with optic neuritis than those who did not develop MS.

Adolescent↗

PubMed2005

[Multifocal visually evoked responses in two children with optic neuritis].

PURPOSE: Central visual functions of two children with idiopathic optic neuritis were analyzed and followed in the course of the disease by using multifocal visually evoked potentials (mVEP) and other ophthalmological tests. SUBJECTS AND METHODS: Two girls 10 and 11 years of age with unilateral optic neuritis participated in this study. At the initial onset of the disease, visual acuity of the patients was below 20/400 and severe central visual field impairment was found in the affected eyes. There were no abnormal neurological or radiological findings suggesting multiple sclerosis in these patients. The mVEPs were recorded with a stimulus of 37 hexagons composed of black and white triangles subtending 35 degrees of visual angle. RESULTS: The amplitude of mVEPs from many stimulating locations was severely reduced in the course of the recovery of these patients. Although visual acuity and perimetric sensitivity in the affected eyes recovered to normal after steroid pulse therapy, the amplitude of mVEPs still remained 1/3 to 1/2 of that of the opposite healthy eye. The mVEPs gradually recovered to near the level of the opposite healthy eyes at the latest examination. CONCLUSIONS: Recovery from the central visual impairment due to infantile optic neuritis is more gradual than that suggested by subjective ophthalmological examinations. There is still optic nerve dysfunction after visual acuity and visual field have recovered to normal. The mVEP is one of the most sensitive tools for detecting optic nerve dysfunction in patients with optic neuritis.

Child↗

PubMed2005

The correlation of changes of the optic nerve diameter in the acute retrobulbar neuritis with the brain changes in multiple sclerosis.

The aim of this paper is to compare diameter of healthy and affected optic nerve determined by ultrasound with brain lesions in acute retrobulbar neuritis in patients with multiple sclerosis. In this prospective study 20 patients with multiple sclerosis and acute retrobulbar neuritis were examined. Optic nerve diameter was measured by ultrasound. Brain lesions were detected by magnetic resonance. Correlation between demyelinating lesions of the brain in multiple sclerosis and optic nerve diameter was tested by Kruskal-Wallis test. Significant difference in diameter between healthy and affected optic nerve in acute retrobulbar neuritis was found. Demyelinating brain changes examined by magnetic resonance revealed periventricular lesions, subcortical lesions and lesions in corpus callosum. There is statistically significant correlation between optic nerve diameter and number of brain lesions in multiple sclerosis, p < 0.05. Diameter of optic nerve in retrobulbar neuritis measured by ultrasound correlates with brain lesions detected by magnetic resonance in multiple sclerosis.

Acute Disease↗

PubMed2006

Management of optic neuritis in a developing African country.

AIM: To show the value of sub-Tenon's depo-methylprednisolone acetate followed by oral prednisolone in the management of optic neuritis in African patients. METHODOLOGY: Two female patients who presented to the University of Benin Teaching Hospital, Benin city, Nigeria and one male patient who presented to the Eye clinic of the Nigerian National Petroleum Corporation, Warri, Nigeria with optic neuritis were given a single dose of sub-Tenon's depo-methylprednisolone acetate 40 mg followed by oral prednisolone 60 mg daily and their vision monitored. RESULTS: In all the 3 cases, there was rapid improvement in visual acuity from as low as ? light perception, counting fingers at 1 metre and at 4 metre to 6/6 within 2-3 weeks with improvement in colour vision. After 3 years and 5 years follow-up in 2 cases, there was no recurrence of optic neuritis and no neurological deficit occurred. CONCLUSION: Sub-Tenon's depo-methylprednisolone acetate followed by oral prednisolone is a safe and effective alternative treatment for optic neuritis in black African patients.

Adult↗

PubMed1991

[Visual functions of optic neuritis in children caused by demyelinating disease].

Optic neuritis in childhood caused by demyelinating disease is very rare, and its effect on visual function has not been well documented. The visual function of 11 patients treated in the last 11 years was retrospectively studied and the results were compared with 15 cases of optic neuritis of unknown etiology. Optic neuritis in children with demyelinating disease was characterized as follows. 1. abnormal visual evoked cortical potentials (VECP) and color vision were found not only in the affected eye but also in the non-affected fellow eye, 2. VECPs became normal long after the recovery of visual acuity, 3. full recovery of visual function took longer, 4. at onset, vision was more severely affected, but showed a good outcome. These findings provide useful information to make a diagnosis of multiple sclerosis even at the first attack of optic neuritis.

Adolescent↗

PubMed1991

[Visually evoked cortical potentials for early detection of optic neuritis in ethambutol therapy].

Ethambutol leads to chronic, severe optic neuritis with sudden onset in approximately 5-14% of all patients. Therefore, the ability of visually (pattern) evoked potentials for the early diagnosis of ethambutol-induced optic neuritis was tested. During ethambutol therapy prolonged latency was documented in 5 of 15 cases (33%). One of these 5 cases showed a reversible decrease in visual acuity. Thus, during treatment with ethambutol visually (pattern) evoked potentials may reveal a surprisingly high percentage of subclinical optic neuritis. These patients need close supervision in order to facilitate early discontinuation of the drug when neuritis develops.

Adolescent↗

PubMed1990

[Measuring temporal transmission properties of the visual system. Diagnostic value in suspected optic nerve neuritis].

The temporal transfer properties of the visual system were examined in 157 patients with suspected acute optic neuritis or papillitis. Foveal modulation sensitivity was measured as a function of temporal frequency (DeLange curve) both for the affected eye and the unaffected fellow eye. Patients with acute optic neuritis typically show a reduction of foveal modulation sensitivity at all temporal frequencies, high temporal frequencies above 10 cps being more markedly affected. The aim of the present study was to determine the sensitivity and specificity of this simple psychophysical procedure for the diagnosis of neuritis or papillitis in a reasonably large population of patients with suspected acute optic neuritis or papillitis. In each case the final diagnosis was confirmed by evaluation of the clinical signs and symptoms, the course of disease and additional diagnostic procedures, e.g. electrophysiology, perimetry, neurological examination including CT, lumbal puncture and examination of cerebrospinal fluid. In 136 cases (86.6%) the result read from the DeLange curve was correctly positive or negative. In 17 cases (10.8%) the DeLange curve indicated a false-positive and in 4 cases (2.6%), a false-negative result.

Flicker Fusion↗

PubMed1990

[MRI lesions of the optic nerves in optic neuritis].

Magnetic resonance imaging (MRI) was performed in 14 patients with optic neuritis. Three patients suffered from multiple sclerosis but the etiologies of the remaining 11 cases could not be identified. They were bilateral in 6, and unilateral in 8. The MR images were compared with the symptomatic lesions of optic neuritis and pattern reversal VECP. The STIR mode (short time inversion recovery), was employed for the MRI in the orbit and T2-weighted mode in the brain. In 11 eyes with hyperemia of the optic disc, 7 eyes showed a high signal in the optic nerve with the MRI, and 9 eyes showed an abnormal pattern VECP. Seven eyes with normal disc and two eyes with a pale disc showed a high signal in the optic nerve with MRI, those 9 eyes had abnormal pattern VECP. The high signal in the optic nerve was not related to visual acuity or visual field abnormalities of patients. However, the degree of the high signal of the optic nerve lesion in MRI was associated with the clinical course and prognosis of the optic neuritis. The degree of the high signal of the optic nerve lesion decreased with the recovery of visual acuity in optic neuritis.

Adolescent↗

PubMed1985

[Subclinical alcoholic optic neuritis without vitamin deficiency].

Vitamin B1, Folic acid Vitamin B12, whole blood Lead level, and plasma Zinc level were determined in 82 patients admitted to an alcoholism rehabilitation program. Each patient was examined for an optic neuritis. Thirty-two of the patients had sub-clinical abnormalities suggestive of optic neuritis like dyschromatopsias and/or field visual defects. No differences were found in the blood levels of Vitamin B1, Folic acid, and Vitamin B12 between the 32% affected and the 68% unaffected subjects. Moreover vitamins blood levels were found to be within the limits of normal values in both groups. A negative correlation between whole blood Lead levels and plasma Zinc levels was found. When an optic neuritis occurs the lead level tends to be higher and the Zinc lower. Abnormalities of the more usual alcoholism tests: gamma glutamyl Transpeptidase (gamma GT), mean red cell volume (V.G.M.) and glutamic Oxaloacetic transferase (T.G.O.), were more pronounced in alcoholics with optic neuritis.

Adult↗

PubMed1982

[Roussy-Levy hereditary areflexic dysstasia. Its historical relation to Friedreich's disease, Charcot-Marie-Tooth atrophy and Dejerine-Sottas hypertrophic neuritis; the present status of the original family; the nosologic role of this entity].

This survey of Roussy-Lévy disease begins with an historical account of the three neurological conditions from which this entity has been separated: Friedreich disease, described in 1861-1863, which proved with time to be a genuine anatomoclinical disorder: Charcot-Marie-Tooth atrophy, described in 1886, particular because of its morphology and evolution but due to various processes: Dejerine-Sottas hypertrophic neuritis, described in 1893, which was the first variant to be individualized within the heterogenous group of primary and familial hypertrophic neuritis. The initial description of Roussy-Lévy disease--in 1926, 1932, and 1934--and the controversies raised by this concept are recalled as well as the present state of the original family: five out of seven members have been examined since 1956 and it has been demonstrated that they are suffering from a form of hypertrophic neuritis. However it is this author's opinion that the concept of an autonomous Roussy-Lévy disease within hypertrophic neuritis is justified by the following criteria: dominant transmission, very precocious onset, extreme slowness of the evolution, remarkable benignity of the prognosis.

Ataxia↗

PubMed1980

[Similar and different features of recurrent homo- and contralateral facial neuritis].

Repeated facial neuritis can be due to diverse etiological factors, such as body cooling, infections, and vascular disorders. In a number of cases these etiological factors cannot be identified. The basis of the pathogenesis of the repeated facial neuritis consists in changed immunobiological reactivity of the body and an anatomic predisposition. On a large number of observations the clinical course and the outcome of repeated homo- and contralateral facial neuritis are described, and for the first time the resemblances and differences between them are characterized. It has been found that in cases of repeated homolateral neuritis the prognosis is worse than in cases of contralateral ones.

Adolescent↗