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PubMed1995

An analysis of VEP components in optic neuritis.

Various VEP parameters were analysed in 126 patients with multiple sclerosis, isolated optic neuritis or isolated myelopathy. The single most common deviation in eyes with clinical evidence of optic neuritis was a prolongation of the latency to P100. After the findings concerning P100 and N70 were combined two patterns of abnormalities emerged: 1) delayed P100 and delayed N70, 2) delayed P100 and absence of N70. In a few cases only one of the potentials was affected. Also in eyes without clinical evidence of optic neuritis the same patterns occurred but discrepancies between N70 and P100 were more common, especially the combination of normal P100 and delayed or absent N70. In about half of these cases the latency to P100 was close to the upper normal limit. It is concluded that in such cases the additional findings of an absent or delayed N70 is strongly suggestive of visual system dysfunction and that the inclusion of N70 in the analysis of VEP may increase the diagnostic yield of the examination.

Adult↗
PubMed1993

[Electrophysiological methods in assessing the risk for the development of multiple sclerosis in adolescents with monosymptomatic optic neuritis].

Pattern electroretinograms and visual evoked potentials (VEP) were investigated in response to reversal checker-board patterns with different sizes of checks in 13 adolescents with monosymptomatic optic neuritis in acute period and in the course of convalescence 1-2 and 12-36 months after the disease onset. All the children underwent computer tomography of the orbit and brain. The results allowed identification of high and low multiple sclerosis risk groups. The high risk can be proved by a progressive increase of VEP latency 1-2 months after the disease onset and its significant advance in later period of optic neuritis. Normal VEP latency in late optic neuritis shows a low degree of its development.

Acute Disease↗
PubMed1993

[Visual evoked potentials in reversal and motion-onset stimulation of visual fields in patients with retrobulbar neuritis].

In 21 patients with unilateral retrobulbar neuritis the pattern reversal evoked potentials and motion-onset visual potentials were investigated with the aim to find out whether there is some difference in affection of pattern detecting (parvocellular) and motion detecting (magnocellular) visual pathways in this disease. The pattern reversal potentials were found to be abnormal in all 21 patients: they showed either significantly prolonged latencies and reduced amplitudes of the main positive P100 peak or no clear response (in one patient) upon the stimulation of the eye with neuritis. In contrast, the main negative peak of the motion-onset potentials was significantly delayed only in 15 patients and its amplitude was distinctly reduced only in 3 patients. The results indicate that in retrobulbar neuritis the pattern detecting nerve fibres from the central part of the retina (tested by reversal potentials) are affected earlier and to a greater extent than the more peripherally distributed motion detecting fibres (tested by motion-onset potentials).

Adult↗
PubMed1993

[A case of optic neuritis following rubella encephalitis].

A 5-year-old boy with left side optic neuritis, which manifested itself 21 days after the onset of rubella eruption, is reported. Seven days after the onset of rash which persisted for 3 days, he was found to be excessively somnolent and disoriented, and a diagnosis of rubella encephalitis was made at our clinic. Clinical symptoms spontaneously subsided 3 days later. Twenty-one days after the appearance of rash (16 days after the onset of encephalitis) he complained of left frontal headache and blurred vision of left eye. The funduscopic examination revealed the left papillitis. Pattern reversal VEP (PVEPs) evoked by stimuli of left eye showed absence of N75 wave, and a prolonged conduction time and low amplitude of P100 wave. Corticosteroid therapy improved his complaints, funduscopic and PVEPs findings. When the treatment was stopped, the funduscopic findings were exacerbated but were improved soon again by the additional corticosteroid therapy. A delayed onset of optic neuritis after the initial infection and a prompt response to corticosteroid therapy may suggest an involvement of some autoimmune process in the pathogenesis of postinfectious optic neuritis in our case.

Child, Preschool↗
PubMed1977

Experimental allergic optic neuritis in guinea pigs: preliminary report.

An experimental model for acute allergic optic neuritis was produced in adult strain 13 guinea pigs by sensitization with isogenic spinal cord emulsion in complete Freund's adjuvant. These animals exhibited two distinct clinical patterns: (1) "retrobulbar optic neuritis," with a diminished pupillary response to light despite a normal fundus, and (2) "neuroretinitis," with a diminished pupillary response associated with hyperemia and swelling to the disc and juxtapapillary retinal edema. Histopathologic study of those animals with "retrobulbar neuritis" revealed that some had no abnormalities in the optic nerve or chiasm, but showed foci of mononuclear cell infiltration in the brain. Others had a mononuclear cell infiltration localized to the retrobulbar portion of the optic nerve and chiasm with multiple foci of axial and periaxial demyelination. Similar pathologic changes were present in the animals with "neuroretintis", but the lesions were located just behind the lamina scleralis. These animals also exhibited marked swelling of the axons at the lamina retinalis. On examination by light microscopy, the alterations in the region of optic nerve head appeared characteristic of papilledema.

Animals↗
PubMed1993

Side effects of glucocorticoid treatment. Experience of the Optic Neuritis Treatment Trial.

OBJECTIVE: To determine the incidence of side effects from short-term glucocorticoid therapy prescribed for treatment of optic neuritis in the Optic Neuritis Treatment Trial. DESIGN: Randomized, placebo-controlled, multicenter clinical trial. SETTING: Fifteen university- or hospital-based centers throughout the United States. PATIENTS: A total of 457 patients between the ages of 18 and 46 years with acute demyelinative optic neuritis were studied. INTERVENTIONS: (1) Intravenous methylprednisolone (250 mg every 6 hours) for 3 days while hospitalized followed by oral prednisone (1 mg/kg per day) for 11 days; (2) oral prednisone (1 mg/kg per day) for 14 days; and (3) oral placebo for 14 days. Each regimen was followed by a short taper. RESULTS: Only two patients experienced major side effects, psychotic depression in one and acute pancreatitis in the other. Both of these patients were from the intravenous methylprednisolone group and both of the side effects resolved without sequelae. Patients in both groups receiving active drugs more often reported sleep disturbances, mood change, stomach upset, and facial flushing and gained more weight during the treatment period than patients in the placebo group (P < .001 for each comparison). CONCLUSIONS: Although minor side effects are common, short-term glucocorticoid therapy in young, healthy adults is relatively safe. Because of the infrequency of serious side effects, outpatient administration of high-dose intravenous glucocorticoids may be feasible.

Acute Disease↗
PubMedDate not supplied

[Spatial contrast sensitivity in the differential diagnosis of optic neuritis].

Contrast sensitivity was examined in patients with optic neurites of different etiology. Achromatic and chromatic (red-black, green-black, and blue-black) sinusoidal patterns were presented in succession against the black background at a frequency of 1-22 cycles/degree on the monitor of an IBM computer. Contrast sensitivity was found altered during exacerbation of optic neuritis on both involved and intact eyes, this indicating a possible involvement of the chiasmal region. The authors discuss a new approach to investigation of the mechanisms of impairment of the optic nerve in optic neuritis in the presence of disseminated sclerosis and neuritis of obscure etiology.

Adolescent↗
PubMedDate not supplied

[Changes in contrast sensitivity in children with optic neuritis].

Changes of spatial contrast sensitivity (SCS) were studied in children with optic neuritis in the acute, convalescent, and remote periods of disease. A selective reduction of SCS of involved and intact eyes in the high frequency band was revealed, indicating the predominant involvement of the parvocellular subsystem of vision in optic neuritis. A correlation of SCS disorders with abnormalities of visual evoked potentials was revealed. The detected regularities indicate shifts on the part of the retrochiasmal structures in patients with optic neuritis, this being confirmed by studies making use of computer-aided tomography and magnetic imaging.

Adolescent↗
PubMed1997

Color vision defect type and spatial vision in the optic neuritis treatment trial.

PURPOSE: To describe the types of color vision defects present in the acute phase of the disease and 6 months into recovery in the 438 participants of the Optic Neuritis Treatment Trial. METHODS: Patients meeting strict eligibility criteria were seen within 8 days of the onset of symptoms and then at regular follow-up visits. At the first and 6-month visits (and subsequent annual visits), spatial vision (acuity, contrast sensitivity), visual fields, and color vision were measured. Farnsworth-Munsell 100-hue tests were scored by a variant of the method of quadrant analysis described by Smith et al (Am J Ophthalmol. 1985; 100:176-182). RESULTS: Most persons show mixed red-green (RG) and blue-yellow (BY) color defects (one type predominating, accompanied by a lesser defect of the other type). BY defects tend to be slightly more common in the acute phase of the disease, with slightly more RG defects at 6 months. Persons may shift defect type over time. Defect type was not related to any of the spatial vision measures at either test time or to treatment group; however, severity of color defect was related to both spatial vision measures and treatment group. CONCLUSIONS: Contrary to common clinical wisdom, optic neuritis is not characterized by selective RG defects. Color defect type cannot be used for differential diagnosis of optic neuritis.

Acute Disease↗
PubMed1997

[Myelitis and optic neuritis caused by varicella].

INTRODUCTION: Varicella mainly affects children between 1 and 14 years old. It is the initial infection caused by the Varicella-Zoster virus. It is characterized by a vesicular cutaneous eruption, fever and generally good prognosis. The neurological complications caused by the Varicella-Zoster virus are infrequent and include: meningitis, encephalitis, cerebellar ataxia, Reye's syndrome, myelitis, optic neuritis, mononeuropathy, polyneuropathy, necrosis of the retina and cerebral arteritis. CLINICAL CASE: We present the unusual case of a woman patient aged 18 who presented with myelitis 15 days after having a varicella rash. Analysis of the cerebrospinal fluid showed intrathecal production of antibodies against the Varicella-Zoster virus. Fourteen days after resolution of the myelitis, she presented with unilateral optic neuritis which remitted without sequelae, (as did the myelitis). Cerebral and medullary MR showed no alterations. CONCLUSIONS: The pathogenesis leading to involvement of the nervous system is still not well defined. Direct invasion by the virus has been postulated, particularly in Herpes-Zoster (reinfection by Varicella-Zoster), as immunological phenomena which may be more frequent with Varicella (initial infection by Varicella-Zoster virus). In our case there were two short episodes of neurological involvement: optic neuritis and myelitis, with a satisfactory clinical course after giving corticosteroids. This makes one think of immunological mechanisms rather than direct invasion of the central nervous system by the Varicella-Zoster virus.

Adolescent↗
PubMed1998

[Residual findings in retrobulbar neuritis during demyelinization].

Retrobulbar neuritis is a common clinical manifestation of multiple sclerosis. We evaluated and compared the results of visual field and fundus examinations, visual evoked response and nuclear magnetic resonance of the brain in 37 patients with the diagnosis of multiple sclerosis and retrobulbar neuritis. Diffuse, peripheral scotomas seemed to be the most often found scotomas on perimetry in these patients. In contrary, central scotomas formed just a little part of the visual field defects. Each threshold increasing of 0.10 log. units on perimetry was followed by increased latencies of 2.5 ms. Each other central scotoma on perimetry decreased the visual acuity of the patient for 1.6 lines on the Snellen chart. The central visual field examination without periphery in the patients with multiple sclerosis and retrobulbar neuritis seems to give false negative results.

Evoked Potentials, Visual↗
PubMedDate not supplied

High resolution Gd-DTPA MR imaging of the inner ear in 60 patients with idiopathic vestibular neuritis: no evidence for contrast enhancement of the labyrinth or vestibular nerve.

Sixty patients with acute idiopathic vestibular neuritis (confirmed by clinical examination and caloric irrigation) were evaluated in a prospective study by high resolution magnetic resonance imaging (hr-MRI) between days 3 and 30 after onset of symptoms. We used a 1.5 Tesla imager with an axial and coronal T1-weighted 2D-fast low angle shot-, T2-weighted turbo spin echo-, and an axial T2-weighted 3D-constructive interference in steady-state sequence for MRI. None of the patients' MRIs exhibited contrast enhancement of the labyrinth, vestibulocochlear nerve, or vestibular ganglion, even when high doses of gadolinium (0.2 mmol/kg) were used. In contrast, several previous studies demonstrated contrast enhancement of the vestibulocochlear nerve/labyrinth in herpes zoster oticus, labyrinthitis, and Cogan's syndrome or of the facial nerve in Bell's palsy. On the basis of our MRI findings, we speculate that idiopathic vestibular neuritis is neither a viral infection directly affecting the nerve (such as herpes zoster) nor a labyrinthitis. An autoimmunological disease of the labyrinth, which should involve only the anterior and horizontal semicircular canals, is also unlikely. A subacute reactivation of a latent viral infection--as discussed for Bell's palsy--is compatible with our MRI findings. The observed differences between contrast enhancement of the facial nerve in Bell's palsy and the vestibulocochlear nerve in vestibular neuritis may be due to their dissimilar anatomy: contrary to the vestibular nerve, the facial nerve has very prominent circumneural arteriovenous structures. Hyperemia within these vascular structures may cause the contrast enhancement seen in Bell's palsy.

Acute Disease↗
PubMed1996

Arterio-venous shunting and proliferating new vessels in acute painful neuropathy of rapid glycaemic control (insulin neuritis).

Insulin neuritis, or painful neuropathy following rapid improvement in glycaemic control, is well recognised but its aetiology is unclear. An understanding of the processes involved in the genesis of acute painful neuropathy of rapid glycaemic control may give an insight into the early pathogenetic factors leading to diabetic nerve damage in general. We have identified five subjects with insulin neuritis including one who developed severe autonomic neuropathy following treatment with insulin. Subjects underwent: 1) assessment of neuropathic symptom and deficit scores; 2) quantitative sensory and electrophysiological studies and 3) sural nerve epineurial vessel photography and fluorescein angiography in vivo. The sural nerve photographs were independently graded by an ophthalmologist. All subjects with insulin neuritis presented with severe sensory symptoms but clinical examination and electrophysiological tests were normal except in the subject with the severe autonomic neuropathy in whom all the tests were abnormal. On nerve photography, there was an abundance of epineurial nutrient vessels although these showed severe abnormalities including arteriolar attenuation, tortuosity and arterio-venous shunting in all subjects. Proliferating neural 'new vessels' which bear striking similarities to those found in the retina and that were more leaky to fluorescein than normal vessels, were observed in three subjects. Venous distension and/or tortuosity was also observed in three subjects and this was most marked in the subject with severe autonomic neuropathy. This study shows that epineurial nutrient vessel anatomy is abnormal in subjects with acute painful neuropathy of rapid glycaemic control, a condition previously thought to be purely metabolic in origin. The presence of epineurial arterio-venous shunting and a fine network of vessels resembling the new vessels of the retina, may lead to a 'steal' effect rendering the endoneurium ischaemic. This process may be important in the genesis of neuropathic pain, and further supports the importance of vascular factors in the pathogenesis of diabetic neuropathy.

Acute Disease↗
PubMed2006

Vestibular neuritis caused by enteroviral infection.

Vestibular neuritis is characterized by the sudden onset of nausea, vomiting, and spontaneous horizontal or horizonto-rotatory nystagmus. The etiology of the disease is multifactorial. Mumps, rubella, herpes simplex virus type 1, cytomegalovirus, and Epstein-Barr virus may have a role in the disease. Enteroviruses are among the other rare causes. This report presents a 7-year-old male admitted with nausea, vomiting, rotatory vertigo, horizonto-rotatory nystagmus with positive Romberg's sign and positive head-thrust test. Cranial magnetic resonance imaging and audiometry of the patient were normal. He was diagnosed with vestibular neuritis, and steroid therapy was initiated. At the second month of follow-up, all symptoms had regressed. To the best of our knowledge, this case report describes the first pediatric patient in whom enteroviral ribonucleic acid is documented both in cerebrospinal fluid and in nasopharyngeal material in active disease. This finding supports the possible role of enteroviruses in the etiology of vestibular neuritis.

Anti-Inflammatory Agents↗
PubMed1987

[Postvaccinal neuritis following prophylactic vaccination against early-summer meningo-encephalitis].

After a single dose of a commonly used commercial vaccine against early-summer meningo-encephalitis a 22-year-old woman developed neuritis of the nerves to the gravity muscles in the legs and feet. The course of the disease and absent antibodies in serum suggested a cellular immune response. In this case, as generally in postvaccinal neuritis, prognosis proved to be favorable. The estimated incidence of postvaccinal neuritis in general is 1:100,000. The indications for active immunization against early-summer meningo-encephalitis should continue to be narrowly defined.

Action Potentials↗
PubMed2000

Vestibular neuritis: three-dimensional videonystagmography and vestibular evoked myogenic potential results.

Eight patients diagnosed with vestibular neuritis received the newly developed three-dimensional videonystagmography (3D VNG) and vestibular evoked myogenic potential (VEMP) examination in order to localize the lesion site. Two (25%) of the 8 patients exhibited spontaneous nystagmus with 3 components, indicating that both the horizontal semicircular canal (HSCC) and anterior semicircular canal (ASCC) were affected. The remaining 6 patients (75%) displayed only horizontal nystagmus, meaning that only the HSCC was involved. Seven (88%) of the 8 patients had bilateral normal VEMPs, revealing sparing of the posterior semicircular canal (PSCC). In a comparative study, another seven patients with vestibular neuritis 1 year post-treatment also received the caloric test, 3D VNG and VEMP examination. Only one patient exhibited spontaneous nystagmus. An absent caloric response of the lesioned side persisted in 5 (71%) of the 7 patients. However, all patients showed normal VEMPs bilaterally. 3D VNG and VEMP examination indicates that vestibular neuritis mainly affects the superior division of the vestibular nerve, which innervates the HSCC and ASCC. Meanwhile, the function of the PSCC and saccule, innervated by the inferior vestibular nerve, is preserved.

Adolescent↗
PubMed2004

Horizontal vestibulo-ocular reflex dynamics in acute vestibular neuritis and viral labyrinthitis: evidence of otolith-canal interaction.

OBJECTIVE: To evaluate the dynamic properties of the horizontal vestibulo-ocular reflex (h-VOR) in the acute stage of two common labyrinthine diseases that provoke severe attacks of vertigo with spontaneous nystagmus: vestibular neuritis (vestibular loss alone) and viral labyrinthitis (cochleovestibular loss). MATERIAL AND METHODS: Sixty-three patients were investigated: 42 were diagnosed with vestibular neuritis and 21 with viral labyrinthitis. The h-VOR function was evaluated by conventional caloric and impulsive testing. A simplified model of vestibular function was used to analyze the vestibulo-ocular response to rotational stimulation. RESULTS: The results showed a significant difference in h-VOR characteristics between the two pathologies. Patients with vestibular neuritis exhibited a strong horizontal semicircular canal deficit, but no h-VOR asymmetry between the two rotational directions. In contrast, patients with viral labyrinthitis demonstrated moderate canal paresis and a marked h-VOR deficit in rotation toward the affected ear. CONCLUSION: These findings support the hypothesis that the h-VOR dynamic asymmetry that occurs after an acute unilateral inner ear lesion is not due to canal dysfunction alone, but involves complex adaptive changes in the central VOR that may implicate the otolith system. Based on histopathologic and clinical differences in the two pathologies reported in the literature, we postulate that this otolith-canal interaction is mainly linked to the loss of saccular function.

Adolescent↗
PubMed2003

The prevalence of trigeminal neuritis with TMD.

Subjects with temporomandibular joint disorder (TMD) occasionally present with additional orofacial pain complaints. These can arise from dysfunction in teeth, bones, ligaments, tendons, nerves, and other structures. In this retrospective study, a group of 501 consecutive subjects with TMD complaints were evaluated for the presence of trigeminal neuritis. Very little information on the prevalence of this condition concomitant with TMDs exists in the literature. The existence of trigeminal neuritis was determined by the presence of pain when palpating trigeminal peripheral nerve branches exiting the supraorbital, infraorbital, and mental foramina in addition to the supratrochlear nerve. Each subject in this study had the involved nerves blocked with local anesthesia injections or lidocaine iontophoresis to assist in confirming the source of pain. Sixty subjects with TMD were found to have trigeminal neuritis. Early recognition of this disorder is important because treatment is usually more successful in the acute peripheral state.

Facial Pain↗