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PubMed1990

Optic neuritis: a prospective study.

We studied 20 patients with acute optic neuritis prospectively for 12 months. Visual fields, color vision, and VEPs to 15' checks were initially abnormal in all patients. Visual acuity was abnormal in 90% and contrast sensitivity in 95% of patients. We devised a graded visual impairment scale (GVIS) to include all visual functions tested. Complete recovery of visual function occurred in 65% of cases. Recovery in the majority of patients was rapid and complete within the first 2 months. In some patients, improvement continued over 6 months. The initial classification on the GVIS was significantly correlated with the final outcome. Patients initially classified as having moderate visual impairment recovered completely or improved to near normal vision. Sixty percent of patients initially classified as total or severe blindness had permanent visual impairment. VEP latency remained prolonged in 19 patients, even when their vision had returned to normal, and is a reliable indicator of resolved optic neuritis.

Adult↗
PubMed1991

Frequency and clinical significance of Lyme seropositivity in patients with isolated optic neuritis.

We evaluated antibody reactivity against Borrelia burgdorferi in 20 consecutive patients with newly diagnosed isolated optic neuritis who resided in a region endemic for Lyme disease. Four (20%) patients had positive serology. All three patients who had follow-up serologies showed rising convalescent levels of Borrelia-specific IgM. One patient refused lumbar puncture, one had normal CSF constituents except for an elevated Lyme antibody index, and two had CSF lymphocytic pleocytosis that remained unexplained after extensive evaluations for causes other than Lyme disease. We treated both patients who had CSF pleocytosis with intravenous ceftriaxone; the pleocytosis and optic nerve function improved. The other two patients received oral antibiotics and showed excellent recovery of visual acuity. We believe that serologic testing for Lyme disease is warranted for individuals with optic neuritis who reside in an endemic region, and patients with rising convalescent antibody levels or unexplained CSF pleocytosis should receive antibiotic treatment for Lyme disease.

Adolescent↗
PubMed1991

Optic chiasmal neuritis.

In four of six patients with clinical optic chiasmal neuritis, MRI demonstrated abnormalities of the chiasm. Optic chiasmal neuritis may be the initial manifestation of multiple sclerosis, a reflection of established CNS demyelination, or an isolated clinical finding.

Adolescent↗
PubMed1998

Visual activation patterns in patients with optic neuritis: an fMRI pilot study.

We studied the use of functional MRI (fMRI) with visual stimulation in nine patients with unilateral optic neuritis. Eight healthy subjects served as controls. Patients showed reduced activation upon stimulation of the affected eye, on average 33% (range 0 to 156%) of the average monocular activation in the control group. Decreased activation was also seen for the unaffected eye (61% of control values, range 3 to 133%). We conclude that fMRI with visual stimulation is feasible in patients with optic neuritis and deserves future study.

Adult↗
PubMed2005

Optic nerve glioma and optic neuritis mimicking one another: case report.

OBJECTIVE AND IMPORTANCE: The clinical and radiographic presentations of optic nerve gliomas and optic neuritis are for the most part distinct and their diagnoses straightforward. We present two cases illustrating the occasional difficulty one can encounter in distinguishing neoplastic from inflammatory optic neuropathies. CLINICAL PRESENTATION: Patient 1 is a 17-year-old girl who presented with acute onset of pain and rapidly progressive visual loss in the right eye. Patient 2 is a 38-year-old man who presented with painless progressive visual loss in the left eye. INTERVENTION: Patient 1 was initially diagnosed with idiopathic retrobulbar optic neuritis. Interval increase of the optic nerve on magnetic resonance imaging prompted a biopsy of the optic nerve, which revealed a pilocytic astrocytoma. Patient 2 was found to have left optic nerve enhancement most consistent with an optic nerve glioma. Before a biopsy, the patient spontaneously improved without treatment, indicating an inflammatory process. CONCLUSION: Differentiating between optic nerve neoplasm and inflammation may be difficult. On occasion, the classic clinical finding of pain with eye movement and the radiographic finding of enlargement and enhancement of the optic nerve may be misleading. Open biopsy of the optic nerve is indicated only after a completely negative metabolic, infectious, and inflammatory workup; interval increase of the optic nerve on magnetic resonance imaging; and failure of the patient to recover vision.

Adolescent↗
PubMed1999

Pachymeningitis and optic neuritis in rheumatoid arthritis: MRI findings.

Rheumatoid arthritis is a systemic disease in which cerebral and eye involvement is neither common nor fully understood. Although it is rarely the cause of pachymeningitis and optic neuritis, rheumatoid arthritis should always be kept in mind in these two conditions. We present a 52-year-old male with an 8 month history of rheumatoid arthritis who was referred to the neurology department with headache and decreasing vision and was diagnosed as having rheumatoid pachymeningitis and optic neuritis on the basis of MRI findings.

Arthritis, Rheumatoid↗
PubMed1996

Human T-cell lymphotropic virus type-I associated myelopathy complicated by optic neuritis.

A 48-year-old Japanese woman from Kyushu was admitted to the Nippon Medical School First Hospital with complaints of numbness in both legs, gait disturbance, and urinary problems. On examination, her lower extremities were spastic with increased reflexes and positive Babinski sign. Sensation was absent below the T4 spinal level. The cerebrospinal fluid contained HTLV-I antibodies and she was diagnosed with HTLV-I associated myelopathy. Her symptoms were resolved with prednisolone, but six months later a visual disturbance of the left eye edema developed. Orbital CT scans showed that left optic nerve was edematous. T2 enhanced MRI revealed a high intensity lesion of the left optic nerve. ERG was normal and no VEP was detected in response to flashing stimulation to the left eye. The HTLV-I antigen titer of CBF was very high. Her optic neuritis improved following oral administration of prednisolone and retrobulbar injections of dexamethasone. This is the first case report of HTLV-I associated myelopathy complicated by optic neuritis.

Anti-Inflammatory Agents↗
PubMed1986

New clinical finding in vestibular neuritis: high-frequency audiometry hearing loss in the affected ear.

Twenty-one patients with established vestibular neuronitis were examined otoneurologically and audiologically. High-frequency audiometry up to 20,000 Hz was performed on all the patients. In 17 cases a high-frequency hearing loss was greater in the ear with vestibular neuritis. The mean hearing loss difference varied from 14 dB to 24 depending on the frequency. Our results reveal that in most cases of vestibular neuritis there are no isolated vestibular lesions, but most cases also involve an auditory end-organ lesion. This finding is in unison with the anatomic conditions of the cochlea and the vestibular end-organ.

Adult↗
PubMed1991

The risk of multiple sclerosis developing in patients with isolated idiopathic optic neuritis in Brazil.

We studied 88 patients with isolated idiopathic optic neuritis (IION) in order to evaluate the rate of progression to multiple sclerosis (MS) in Brazil. The patients were reassessed from one month to nine years after the development of the IION (mean follow-up was 4.6 years). There were 52 men and 36 women with ages ranging from three to 59 years (mean 24.3 years). Bilateral optic neuritis occurred in 19 patients whereas sequential involvement of the fellow eye after an interval longer than four weeks occurred in other 19 patients. Recurrences in the same eye occurred in seven cases. Nine patients (10.8%) developed clinically definitive MS--13.9% of the women and 7.7% of the men with IION. The median age at the time of diagnosis of MS was 25 years. The mean interval between IION and the emergence of other MS signs varied from one month to five years--median one year. Sixty-seven percent of these patients developed signs of spinal cord involvement. Our findings when compared to published series in different countries are closer to figures reported in Japan than those in the West.

Adolescent↗
PubMed1997

[Etiological and clinical characteristics of infectious optic neuritis].

Fifty-one patients with infectious optic neuritis (ION) with no associated choroidal or retinal involvement were studied in relation to the etiologic agents, and to the epidemiological and clinical features to look up features which could be used to distinct them from the demyelinating optic neuritis (DON) which have a well-known tendency to convert to multiple sclerosis. Bilateral involvement was found in 23 patients (45.1%), simultaneously in 18 cases. Sex distribution was 2M:1F. The ages ranged from 1 to 82 years (median 34.8); 1/3 of the patients were younger than 20 and 1/3 were 50 years of age or older. Syphilis was found in 19 patients being the single most common etiology, whereas viral infections were found in 41.2% of the cases. Visual acuity was severely damaged in most patients and was worse than 20/200 in 57.3% of the involved eyes. Color vision was affected in 91.8%. Visual field defects were found in 92.2%, with predominance of the central defects (40.7%). The optic disc was abnormal in 90.5% of the eyes. This study clearly demonstrates that ION and DON have distinct epidemiological and clinical features. The awareness of these differences may help clinicians to follow different paths for the correct diagnosis and appropriate treatment and prognostic orientation of their patients.

Adolescent↗
PubMed1975

The neuroradiologic evaluation of "optic neuritis".

Optic neuritis, even when clinically typical, cannot be diagnosed with certainty because mass lesions compressing the anterior visual pathways may mimic it. The radiologist is in a position to assist in identifying such lesions or in ruling them out and thus preventing surgical exploration. While every patient in whom the diagnosis of optic neuritis is entertained should have plain roentgenograms of skull, orbits and optic canals, we have developed a schema for detailed neuroradiologic investigation based on clinical and plain roentgenographic findings. A classification of such lesions by location is illustrated.

Adolescent↗
PubMed1997

Optic neuritis: imaging with magnetization transfer.

OBJECTIVE: Our objective was to prospectively examine the optic nerves in patients with clinically severe unilateral optic neuritis, using routine spin-echo and magnetization transfer MR imaging. SUBJECTS AND METHODS: For 39 patients with such lesions, we calculated the magnetization transfer ratio along the involved intraorbital optic nerve and along the asymptomatic contralateral optic nerve in a mirror-image location. Magnetization transfer ratios were correlated with the imaging findings on routine spin-echo MR imaging. RESULTS: Magnetization transfer ratios were decreased in 33 of the 39 clinically symptomatic optic nerves, including 12 of the 18 clinically symptomatic optic nerves in which no abnormality was seen on routine spin-echo MR images obtained before and after administration of gadopentetate dimeglumine. CONCLUSION: Magnetization transfer imaging reveals intraorbital optic nerve abnormalities in patients with optic neuritis even when such lesions are otherwise occult on routine magnetization transfer imaging.

Adult↗
PubMed1993

Dynamic properties of feed back control of human posture in subjects with vestibular neuritis.

Postural control was studied in 22 subjects with vestibular neruitis within 14 days after the onset of symptoms. Dynamic feed back control of posture were evaluated by analyzing the postural responses to vibration toward calf muscles applied according to a PRBS schedule. Properties of the dynamic control was normalized as swiftness, stiffness and damping of the responses. There was no prominent group differences between the 22 subjects with vestibular neuritis and 17 normal subjects. However, when studying the change in parameters evoked by presence or absence of visual information it was found that the abundant changes of control parameters, especially in stiffness, met in normal subjects had declined in subjects with vestibular neuritis. The present finding suggests that although subjects after an acute vestibular lesion may achieve a sufficient postural control by utilizing information from other somatosensory receptors, this is concomitant with changes of the feed back control.

Adult↗
PubMed1996

Functional coupling between the central-autonomic and the cognitive systems is enhanced in states after optic neuritis and early multiple sclerosis.

We studied the relation between central-autonomic adaptability (largest Lyapunov exponent of heart rate dynamics) and visual learning capability (total net score in Kimura's Recurring-Figures-Test) in 15 healthy subjects and 35 patients with cerebral white matter diseases (12 with optic neuritis and 23 with multiple sclerosis), aged between 18 and 39 years. In optic neuritis patients and in those with very early, clinically asymptomatic multiple sclerosis, we found high correlations between these central-autonomic and cognitive functions (r = .66 and r = .86, respectively, p < .02). In contrast, in healthy subjects and in patients suffering from an already clinically symptomatic multiple sclerosis, there were no such significant correlations. These results are interpreted in terms of stochastic resonance within a postulated meta-system which integrates autonomic and cognitive functions.

Adolescent↗
PubMed1987

The visual evoked potential contrast response function in recovering optic neuritis.

VEP contrast response functions were obtained in 7 patients with recovered optic neuritis and in 6 age-matched controls. A 1.5 c/d sinusoidal grating was counterphase modulated at 4 Hz (8 reversals/sec) about a mean screen luminance of 141 cd/m2. Grating contrasts ranged from 2% to 85% and were randomly presented. In all control observers, VEP amplitude was a nonmonotonic function of contrast; an amplitude inflection occurred between contrasts of 33% to 47% followed by a sharp increase in amplitude at higher contrasts. The slope of the function relating VEP phase to contrast was variable between observers at low contrasts but consistently "flat" at high contrasts. In spite of normal acuity and contrast sensitivity, VEP amplitude was severely attenuated at high contrasts in all optic neuritis eyes but there were no contrast-dependent phase abnormalities. The results were directed toward the issues of a) suprathreshold contrast processing in optic neurtis, b) relating a nonmonotonic VEP amplitude function to the contrast-segregating properties of single cells, and c) the relationship between VEP abnormalities and visual performance.

Adult↗
PubMed2000

Optic neuritis after bee sting.

The purpose of this report is to document an unusual case of fully recovered vision after optic neuritis caused by bee sting. A 46-year-old man presented with sudden visual loss after being stung by a bee on the left conjunctiva. He developed optic disc swelling and there was a delay in the P100 wave of the pattern visual evoked potential (VEP). The patient received acute treatment, with intravenous methylprednisolone followed by oral prednisolone. Two days later, visual acuity in the left eye was recovered to 20/20 and P100 latency in pattern VEP was also normalized. Furthermore, visual field and color vision tests revealed no remaining abnormalities. This case suggests that early corticosteroid treatment is effective in optic neuritis caused by bee sting.

Animals↗
PubMed2006

Multiplex neuritis in a patient with autoimmune hepatitis: a case report.

A 37-year old woman presented with a 9-year history of hepatitis of unknown origin and aminotransferases within a 3-fold upper limit of normal. Autoimmune hepatitis (AIH) was diagnosed on the basis of elevated aminotransferases, soluble liver antigen/liver pancreas (SLA/LP) autoantibodies and characteristic histology. Immunosuppressive therapy led to rapid normalization of aminotransferases. Two years later, the patient developed left sided hemisensory deficits under maintenance therapy of prednisolone and azathioprine (AZT). Later she developed right foot drop and paraesthesia in the ulnar innervation territory on both sides. Magnetic resonance imaging (MRI) and cerebral panangiography suggested cerebral vasculitis. Neurological investigation and electromyography disclosed multiplex neuritis (MN) probably due to vasculitis. Consistent with this diagnosis, autoantibodies to extractable nuclear antigens were detectable in serum. Immunosuppression was changed to oral 150 mg cyclophosphamide (CPM0) per day. Prednisolone was increased to 40 mg/d and then gradually tapered to 5 mg. Oral CPM was administered up to a total dose of 40 g and then substituted by 6 times of an intervall infusion therapy of CPM (600 mg/m(2)). Almost complete motoric remission was achieved after 3 mo of CPM. Sensibility remained reduced in the right peroneal innervation territory. Follow-up of cranial MRI provided stable findings without any new or progressive lesions. This is the first report of multiplex neuritis in a patient with autoimmune hepatitis.

Adult↗