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At least 325 records · Page 18Linked to original sources

Bilateral optic neuritis in childhood.

A 12-year-old male presented with a one-day history of visual failure. The clinical features were consistent with bilateral optic neuritis. Treatment with prednisolone resulted in visual function returning to normal. Bilateral optic neuritis in childhood is an uncommon condition. The aetiological factors differ from those of the adolescent and adult with optic neuritis. The childhood condition is not associated with the high risk of developing demyelination disease at some later stage.

Child↗

The National Eye Institute Visual Function Questionnaire: experience of the ONTT. Optic Neuritis Treatment Trial.

PURPOSE: To describe the health-related quality of life, measured with the National Eye Institute Visual Function Questionnaire (NEI-VFQ), of patients several years after the onset of optic neuritis, according to their neurologic and visual status; to assess the relationship between the NEI-VFQ subscales and clinical measures of visual function; and to assess the internal consistency reliability of the NEI-VFQ subscales. METHODS: The NEI-VFQ was administered to 244 patients 5 to 8 years after treatment for an episode of acute optic neuritis as part of the Optic Neuritis Treatment Trial. Visual acuity, visual field, contrast sensitivity, and color vision were measured at the same time as questionnaire completion. RESULTS: The NEI-VFQ scores generally were lower than those reported for a disease-free group. Reported dysfunction was greater when multiple sclerosis was present and when visual acuity was abnormal, supporting the construct validity of the NEI-VFQ. Rank correlations between the NEI-VFQ subscales and clinical measures of visual function were moderate at best. Internal consistency reliability was generally high for most of the NEI-VFQ subscales. CONCLUSIONS: These findings add support to the use of the NEI-VFQ as a valuable measure of self-reported visual impairment.

Acute Disease↗

[Devic disease: a rare cause of retrobulbar optic neuritis: a case report].

A case of 58-year-old woman with recurrent retrobulbar optic neuritis (ron) and transverse myelitis is presented. The patient was admitted to the opthalmology unit because of acute right retrobulbar optic neuritis. In 1997 she complained of left retrobulbar optic neuritis. One year later transverse myelitis of thoracic spine with spastic paraparesis occurred. MRI examination showed T2 hyperintensive focus in the thoracic spine (Th8-Th9, probably demyelinisation). Nowadays MRI examination of the optic nerves and brain showed demyelinisation focus in the right optic nerve. There was no pathological changes in the brain. The diagnosis of Devic disease was established. Treatment with intravenous methyloprednisolon was administered with slight improvement. The pathology and clinical course of Devic disease are discussed.

Anti-Inflammatory Agents↗

Frequency doubling perimetry in resolved optic neuritis.

PURPOSE: To study the visual field with frequency doubling technology (FDT) in patients with recovered optic neuritis and to detect loss of magnocellular projecting cells (M cells) in the extrafovea. METHODS: Fourteen patients who had undergone one attack of optic neuritis and recovered normal vision (1.0 or better) and critical fusion frequency were examined with conventional Humphrey automated perimetry central 30-2 and FDT c-20 threshold tests. After 1 year, 12 patients were reexamined with central 30-2 and FDT c-20 tests. The visual fields examined by both perimeters were divided into three zones. The mean sensitivity in each zone in involved eyes, uninvolved eyes, and involved eyes after 1 year was compared with that in healthy eyes. RESULTS: Conventional automated perimetry showed depression toward the fovea. However, FDT demonstrated general depression, especially midperipheral deficits. After 1 year, the midperipheral deficits with frequency doubling perimetry (FDP) improved, as did central depression, as observed with central 30-2 tests. CONCLUSIONS: FDT was developed to detect early glaucomatous damage, which was thought to be caused by a loss of M cells. Our study suggested that patients with resolved optic neuritis also had a loss of M-cell function in the extrafoveal area, as observed by field damage and its recovery.

Adult↗

Acute brachial plexus neuritis: an uncommon cause of shoulder pain.

Patients with acute brachial plexus neuritis are often misdiagnosed as having cervical radiculopathy. Acute brachial plexus neuritis is an uncommon disorder characterized by severe shoulder and upper arm pain followed by marked upper arm weakness. The temporal profile of pain preceding weakness is important in establishing a prompt diagnosis and differentiating acute brachial plexus neuritis from cervical radiculopathy. Magnetic resonance imaging of the shoulder and upper arm musculature may reveal denervation within days, allowing prompt diagnosis. Electromyography, conducted three to four weeks after the onset of symptoms, can localize the lesion and help confirm the diagnosis. Treatment includes analgesics and physical therapy, with resolution of symptoms usually occurring in three to four months. Patients with cervical radiculopathy present with simultaneous pain and neurologic deficits that fit a nerve root pattern. This differentiation is important to avoid unnecessary surgery for cervical spondylotic changes in a patient with a plexitis.

Acute Disease↗

[Follow-up studies of optic neuritis with lymphocytic adenohypophysitis].

BACKGROUND: We report a 38-year-old female suffering from bilateral optic neuritis with lymphocytic adenohypophysitis. CASE: The initial symptom of the 38-year-old-female was diabetes insipidus. Magnetic resonance imaging showed swollen pituitary stalk and disappearance of the T1 shortening of the neurohypophysis. Immunological tests showed that the serum anterior pituitary antibody was positive. These findings suggested lymphocystic adenohypophysitis. Bilateral optic neuritis also occurred and the pattern visual evoked cortical potential (VECP) demonstrated increased P100 peak latency and reduction of amplitude. After steroid pulse therapy, the visual acuity and field improved and the pattern VECP became normal. Temporal hemianopia was not noted. CONCLUSION: A direct infiltration of the inflammatory change in the pituitary gland or some autoimmune problem was considered as a cause of the optic neuritis. In contrast to the VECPs of multiple sclerosis patients, the prolonged peak latency of pattern VECPs of this case were shortened in accordance with the recovery of visual acuity.

Adult↗

Surgical decompression of posterior tibial neurovascular complex in treatment of certain chronic plantar ulcers and posterior tibial neuritis in leprosy.

Seventy-one cases of posterior tibial neurovascular surgical decompression in leprosy are analyzed and reviewed. Thirteen had chronic refractory posterior tibial neuritis while 58 had chronic nonhealing plantar ulcers. The plantar ulcers were associated with posterior tibial neuritis and/or vascular insufficiency. The clinical and operative findings together with the results are presented and the physiopathology of neurovascular compression is discussed. The operative procedure is described. The presence of pale granulation tissue in a nonhealing ulcer seems to be a characteristic finding in these cases. Neurovascular compression in the tunnel, behind and also below the malleolus, was present in all. In operative procedures, the importance of incising the inferior calcaneal bands is stressed. The results show that the neuritis was cured in all cases, while in 53 of 58 cases the plantar ulcers healed in a short period after the decompression. This stresses the value of this procedure. The prophylactic potential of this procedure needs to be evaluated.

Adolescent↗

Change of visual acuity and related factors in idiopathic optic neuritis.

PURPOSE: To study the change of visual acuity and related factors in idiopathic optic neuritis. METHODS: Retrospectively studying 136 cases (210 eyes) of idiopathic optic neuritis hospitalized in our department during last 5 years. The data was analyzed with the methods of multivariate stepwise regression analysis by SPSS statistic package. RESULTS: The final visual acuity was very strongly related positively to the initial visual acuity at the time point of starting treatment and negatively to the time span beginning the treatment to the time showing improvement, age of patient and the duration from onset of the disorder to the time point of treatment beginning. CONCLUSIONS: Promptly right treatment can significantly change the natural course and the final vision of optic neuritis. Severe visual loss, old age, longer time without right therapy and slow improvement after the treatment may indicate an unfavorable final visual recovery. The different dosages of steroid applied in this study was not significant in view of the final visual acuity.

Adolescent↗

[Pathogenesis of retrobulbar neuritis].

Biological fluids from 146 patients with retrobulbar neuritis were examined for the biochemical, immunochemical and immunologic characteristics that mirror destructive processes in myelin and changes in the system of the cholinoglycine cycle which is one of the stages of the synthesis of myelin in the oligodendrocyte. In the majority of observations, the changes in these reactions of different directions and of varying intensity were revealed. Based on the data obtained the conclusion is made that part of the patients with retrobulbar neuritis may be attributed to multiple sclerosis since according to the laboratory findings, the demyelinating process occurring in them goes beyond optic nerves. Besides, it has been shown with special reference to retrobulbar neuritis that the primary affect, possibly of the viral nature, is likely to be localized in the oligodendrocyte, with myelin being involved in the process for the second time.

Humans↗

Peripheral neuritis due to isoniazid.

It is well known that in the treatment of tuberculosis with isoniazid the complication of peripheral neuritis may arise. This complication is normally rare when small dosages of the drug are used, but a high incidence of the neuropathy has recently been observed in East Africa in a group of malnourished tuberculous patients receiving isoniazid in comparatively low dosage (4-6 mg/kg body-weight daily). The present paper reports on 20 cases of peripheral neuritis encountered in Madras, India, among 338 poorly nourished tuberculous patients during a trial of four isoniazid regimens, two of low and two of high dosage (3.9-5.5 and 7.8-9.6 mg/kg body-weight daily, respectively). Nineteen of the 20 cases occurred in the two groups of patients receiving the high dosage and these 19 patients were found to have a higher mean serum level of free isoniazid than the patients in the same groups who did not develop the complication. The authors consider that dosages of 7.8-9.6 mg/kg body-weight daily should not be used for the mass therapy of poorly nourished patients unless steps are taken to prevent the development of peripheral neuritis. Pyridoxine has been reported to be an effective preventive, but is too expensive for use on a large scale. This study indicates, however, that administration of the cheaper vitamin B complex might give satisfactory results and warrants further investigation.

Africa, Eastern↗

Acute optic neuritis associated with immunization with the CNS myelin proteolipid protein.

Optic nerve tissue for SJL/J mice immunized with the central nervous system (CNS) myelin-specific proteolipid protein (PLP) was examined for histopathologic evidence of optic neuritis. Optic nerves isolated 17 d after immunization with PLP revealed an interstitial and submeningeal inflammatory infiltrate consisting of neutrophils and monocytes. In all cases, histologic evidence of optic nerve involvement correlated serologically with the presence of circulating anti-PLP antibodies. Control animals had no histopathologic evidence of disease or anti-PLP antibody. In many respects, the observed histopathologic profile of PLP-induced optic neuritis is similar to that associated with human inflammatory demyelinating diseases such as multiple sclerosis (MS). Because optic neuritis frequently is associated with some of the earliest clinical symptoms of MS, the acute nature of optic nerve involvement in this animal model suggests that immune recognition of the myelin PLP may play a significant role in the pathophysiology of optic nerve damage associated with sensitization to CNS-specific antigens.

Acute Disease↗

[Pulse therapy in the treatment of optic neuritis in multiple sclerosis].

Corticosteroids are the preparations in the treatment of optic neuritis at multiple sclerosis. The doses and methods of introduction of corticosteroids are chosen individually for the adults and children. A maximum effect is registered in a majority of cases of optic neuritis, when methylprednisolone is prescribed with the pulse-dose introduction, as compared to parabulbar injections or administration of corticosteroids per os. The recovery of vision at relapsing optic neuritis sets on faster and is of a more prolonged nature as compared to other variants of the introduction of corticosteroids. Therefore, the prescription of methylprednisolone as pulse-doses is more effective in both adults and children.

Administration, Oral↗

Bilateral optic neuritis in pregnancy.

A 25-year old primigravida at 11-weeks period of amenorrhoea presented with bilateral optic neuritis following Varicella Zoster viral (VZV) infection. She was serologically positive for systemic lupus erythematosus but negative for virus. The exact pathogenesis of the patient's severe optic neuritis, adduction and neurological deficit was unknown. The initiation of high dose steroids for optic neuritis was a big clinical dilemma in a pregnant patient with viral infection. The patient was treated with high dose steroids after three days of commencement of antiviral treatment. At 6 months after presentation, her visual acuity in the right eye was 6/36 with perception to light in the left.

Adult↗

[Autoimmune optic neuritis].

We describe two patients with autoimmune optic neuritis. The initial symptom was severe loss of vision without clinical signs or symptoms of systemic autoimmune disease. The patients had recurrent attacks of optic neuritis in both eyes, causing permanent visual impairment despite conventional doses of corticosteroid. The only laboratory sign of autoimmune disease was a positive antinuclear antibody (ANA). These patients must be differentiated from cases with idiopathic optic neuritis or multiple sclerosis. Early diagnosis and high-dose corticosteroid therapy may be necessary, and may be successful in restoring visual function. Continued therapy with cytotoxic agents may be required.

Adult↗

[Optic neuritis--diagnosis, treatment and follow up].

A national group of neurologists and ophthalmologists have evaluated guidelines and recommendations for diagnosis, treatment and follow up of optic neuritis based on clinical experience and a review of relevant literature. Optic neuritis is a common, well characterised condition that appears as an isolated syndrome or as a manifestation of multiple sclerosis. Several other diseases must be considered for a differential diagnosis. Corticosteroid treatment of optic neuritis has been investigated in a number of trials, which show that corticosteroid treatment speeds up the recovery of vision without affecting the final visual outcome. The diagnostic procedure and the treatment options have changed over the last few years. Some aspects of investigation, treatment and follow up are still controversial.

Diagnosis, Differential↗

Optic nerve diffusion measurement from diffusion-weighted imaging in optic neuritis.

BACKGROUND AND PURPOSE: Increases in apparent diffusion coefficient (ADC) from diffusion-weighted (DW) imaging are thought to be due to axonal disruption, and changes have been well documented in multiple sclerosis lesions. DW imaging of the optic nerves, however, presents many challenges. The goal of this study was to measure ADC in patients with optic neuritis by using zonal oblique multisection echoplanar imaging. METHODS: The optic nerves of eighteen patients who had experienced an attack of optic neuritis 1 year previously and 11 control subjects were imaged with the diffusion sequence (usable data were available from 16 patients and 10 control subjects). The orbital optic nerves were segmented by a blinded observer by using a computer-assisted threshold-based contouring technique, and the mean ADC was determined. RESULTS: The mean ADC from diseased optic nerves was 1324 x 10(-6) mm2/s, compared with 990 x 10(-6) mm2/s from healthy contralateral optic nerves (P = .005 versus diseased optic nerves) and 928 x 10(-6) mm2/s from control optic nerves (P = .006 versus diseased optic nerves and P = .40 versus healthy contralateral optic nerves). The diseased optic nerve ADC correlated with both visual (e.g., r(S) = 0.73; P = .001 for logMAR visual acuity) and electrophysiological parameters (e.g., r(S) = -0.57, P = .021 for visual evoked potential central field amplitude [VEP]). CONCLUSION: It has been possible to apply DW imaging in a patient population, and, in the chronic phase following optic neuritis, the correlation of mean ADC with the clinical and electrophysiological parameters suggests that the ADC is giving a surrogate measure of axonal disruption in the chronic, postinflammatory optic nerve lesion.

Adult↗

Rapidly developing optic neuritis secondary to ethambutol: possible mechanism of injury.

Optic neuritis has been described among the toxic effects of Ethambutol. This side effect is dose related. The mean duration of Ethambutol induced optic neuritis (EON) is three months. We report a case of EON after few days of exposure to Ethambutol and the symptoms resolved after discontinuation of Ethambutol. This most likely represents an idiosyncratic reaction which is different as compared to dose related optic neuritis.

Adult↗

Epidemiology of monosymptomatic optic neuritis in Rijeka County, Croatia: meteorological aspects.

In order to analyze the meteorological factors possibly influencing the monosymptomatic optic neuritis in Rijeka County, northwestern part of Croatia, retrospective analysis of all cases diagnosed in Rijeka County in period from 1977 to 2001, was done. Meteorological data on monthly and yearly temperature, humidity, insolation in Rijeka County were collected from Croatian Meteorological and Hydrological Service. In the observed period there were 173 cases of monosymptomatic optic neuritis, female/male ratio was 1.66, and overall incidence was 2.18/100,000 inhabitants. There was no correlation of incidence with average yearly and monthly temperature, humidity, insolation, or month of birth. This is the first study on meteorological factors and optic neuritis in Croatia.

Adolescent↗