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An HIV-positive man with subacute syphilitic meningitis developed severe bilateral visual loss from optic neuritis. His visual acuity improved remarkably within 24 hours after single posterior sub-Tenon's injections of triamcinolone (Kenalog) were given. Periocular steroid injections should be considered as an adjunctive treatment of syphilitic optic neuritis.
A rare case of bilateral optic neuritis is presented in a child with no light perception. Ophthalmic examination revealed dilated pupils without reaction to the light, swollen optic discs with small peripapillary hemorrhages in both eyes. Serology revealed evidence of recent Epstein-Barr virus infection. After treatment with high dose of corticosteroid visual acuity gradually improved. After four months visual acuity was normal despite complete pallor of the optic disc. Ebstein-Barr virus infection should be considered in the differential diagnosis of bilateral optic neuritis in a child with severe bilateral visual loss.
The relationships between relative afferent pupillary defect (RAPD) and visual evoked potential (VEP), visual acuity or visual field in 14 patients with idiopathic unilateral optic neuritis, were investigated during the period of recovery from an acute episode. Grading of RAPD into four steps mainly based upon an escape phenomenon in a swinging flashlight test, was used to determine the degree of RAPD. The degree of RAPD significantly correlated with a reduction in VEP amplitude, visual acuity and loss of central visual field, while it did not correlate with delay in VEP latency. These results suggest that RAPD is mainly related to the integrity of central vision, and that grading of RAPD, as well as a comparison of VEP amplitude between the affected and contralateral eyes, is useful for an objective evaluation of visual functions of the affected eyes in patients with unilateral optic neuritis.
Visual evoked potentials (VEP) to chess pattern reversion were studied in 17 children with optic neurites during the acute stage and in the course of convalescence 1-2 months and 1-3 years after the disease onset. Coarse VEP changes were detected in the patients during the acute stage of optic neuritis. A positive time course of VEP was followed up in late periods after the acute attack of the disease. Despite normalization of vision acuity, no complete restoration of VEP to small-cell chess patterns was seen. The findings evidence that studies of VEP to chess pattern reversion should be carried out to detect subclinical involvement of the optic nerve and to timely diagnose optic neuritis in children.
In the course of 1 year we investigated 32 patients suffering from retrobulbar neuritis, using photographs of the retinal nerve fiber layer (RNFL). All photographs revealed defects of the RNFL in the area of the papillomacular bundle. These observations were compared with photographs of eyes not affected by any ophthalmological diseases. No loss of retinal nerve fiber bundles was found in any of these cases. One remarkable finding of this study was that 90% of the patients with retrobulbar neuritis also had defects in the RNFL of the contralateral eye.
We studied the extent of optic nerve lesion with magnetic resonance imaging (MRI) in 24 patients with optic neuritis and compared it with visually evoked cortical potentials (VECP). Patients were divided into acute and chronic stage groups according to the duration of the disease from its onset. The short TI inversion recovery (STIR) mode of the MRI was selected for study. In the acute stage group, abnormally high signals of optic nerve on MRI were demonstrated in 11 of 12 eyes, and the amplitude and peak latency of pattern VECP were unrelated to the extent of the optic nerve lesion visualized by MRI. Conversely, in the chronic stage group, the abnormal MRI findings were exhibited in 19 of 23 eyes, and the relationship between the measurements was statistically significant. This difference in the optic nerve lesion observed by MRI between the acute stage and the chronic stage of optic neuritis may indicate pathophysiologic differences in their origins.
Twenty eight cases (50 eyes) of chronic open-angle glaucoma and 21 cases (27 eyes) of optic neuritis were investigated with FM 100-hue test and panel D-15 test. In patients with optic neuritis, 70.37% and 85.19% of the affected eyes appeared abnormal in Panel D-15 test and FM 100-hue test respectively. The main defects were tritan-like in both of the tests. In patients with chronic open-angle glaucoma, 20% and 32% of the affected eyes had abnormal results in Panel D-15 test and FM 100-hue test respectively. The main defects were also tritan-like color vision defect. The total error scores of FM 100-hue test in patients with chronic open-angle glaucoma had no relation with the cup disc ratio and the area of peripheral visual field but had relation with the area of central visual field.
Optic neuritis can be mimicked by ophthalmologic, neurosurgical, and other conditions. In many if not all cases, optic neuritis may be a manifestation of multiple sclerosis. An ongoing treatment trial may provide answers about whether or not treatment improves outcome.
A new method for diagnosing vascular neuritis of optic nerve by means of thermography is proposed. Among 47 patients with diagnosis of optic nerve neuritis of unclear etiology, in 37 of them vascular genesis of the disease was diagnosed. The thermograms have shown appearance of dark "cold" spots and a fall of temperature by 1.0 degrees C and lower in the supraorbital and orbital areas of the affected eye. The method is highly precise (90.27%, sensitive (94.9%) and doesn't require long time.
A clinical and immunological study was carried out in 75 patients with facial neuritis. It was found that the concentration of serum IgG and IgA were increased. The frequency of CIC in blood was higher than normal. In comparison with the controls, the difference was statistically significant (P less than 0.01). However, IgM, Ch50 and C3 levels were not deviated from normals. It was suggested that immune functions of patients with facial neuritis were abnormal. The data presented might set a clue in exploring the pathogenesis of this disease. Of these 75 cases, 2 were bilateral simultaneous Bell's palsy, 11 unilateral recurrent and bilateral alternating Bell's palsy. They might be considered as special types of Bell's palsy.
The symptoms and signs of twenty-one children under 15 years of age with optic neuritis are presented here. The optic neuritis often was bilateral and accompanied by papilledema. In the acute stage there was however no typical central scotoma in every case. Some children had only peripheral visual field defects. The visual disorder will not improve so much as is general assumed: a slight decrease of visus and visual field defects in static perimetry usually persist. Half of the children developed signs of multiple sclerosis within a few years.
The methods of primary and secondary prophylaxis of cochlear neuritis in workers exposed to a high noise level are described. It is emphasized that hearing impairment can be prevented in a more efficient manner at the early stages: noise effect on the hearing organ and signs of the effect or mild symptoms of cochlear neuritis. A complete scheme of therapy is presented which includes vasodilators, vitamins, biostimulants, sedatives, physiotherapy. It is stressed that methods of primary and secondary prophylaxis applied in due time can prevent appearance and development of hearing impairment and potential invalidism of workers working in a high noise environment.
The clinical and electrophysiological evolution of a 24-year-old patient with Miller-Fisher's syndrome and findings of mild peripheral neuropathy in the electromyographic study is reported. The patient had been treated six years previously for a similar disease and he recovered in 2 months. During the plasmapheresis therapy of the second episode he developed pain and weakness of the left shoulder girdle, and the EMG was consistent with bilateral brachial neuritis. The disease had improved clinically after 6 weeks, except for supracapsular brachial neuropathy; this territory remained denervated after 3 months of evolution. A diagnosis of Crohn's disease had been made between both episodes. The discussion focuses on the rarity of recurrent forms of Miller-Fisher's syndrome and the association of the reported case with brachial neuritis and Crohn's disease.
A prospective study was carried out on 27 patients with optic neuritis. Besides detailed clinical examination, visual evoked responses (VER) were studied utilising the checker board pattern reversal and flash stimuli. The recording with the 30 minute check size was found to be the most consistent both for the controls and the patients. Flash evoked VER was most useful in determining the wave form in cases with severe disruption of the visual pathways. Neither the implicit time nor the amplitude of the VER could be directly correlated to the visual acuity changes or other clinical parameters. Implicit time offered a more reliable criterion for evaluation as compared to the amplitude in patients with optic neuritis. The VER recording helps in serial follow-up of a patient and can indicate previous attacks suffered by the patient.
An epidemiologic and clinical study on optic neuritis in two sanitary districts of the Sardinia was carried out. The results were partially in agreement, partially in contrast with the literature data. The most important datum is that the annual incidence rate of optic neuritis in Sardinia is similar to the rates observed in medium-high risk for MS geographical areas, according to observation which showed that frequency of MS in Italy, and in Sardinia particularly, is much higher than that indicated by previous studies.
The suggested complex of the perimetric and electrophysiologic methods for the assessment of the function of the visual analyzer has helped detect diffuse involvement of the ocular system in clinically unilateral retrobulbar neuritis and define the incidence rate of involvement of the contralateral normal optic nerve. Prolongation of the latency of visual perception appears to be characteristic of retrobulbar neuritis and indicates the demyelinization of the nerve visual fibers.
We compared the visual field in 46 eyes of 34 cases with optic neuritis, which included 17 cases with multiple sclerosis (MS) and 17 cases with unknown causes. The visual field examination was measured by program 31 of the Octopus automated perimeter, which tests the central 30 degree field in a 6-degree grid. All eyes had visual acuity of 0.2 or better. The mean visual acuity was 0.97 in MS and 0.83 in the unknown etiology cases. There were no differences in the rate of abnormalities in the 30 degree-field between MS and unknown cases. The mean sensitivity loss of the abnormal visual field with MS was significantly greater than that of the unknown cases. The 30 degree field was divided into 3 sections. MS had almost the same mean sensitivity loss in each section. The cases of unknown etiology had a greater mean loss in 0-10 degrees than that in the other sections. We could conclude therefore that diffuse visual field loss was caused by MS and central depression of 0-10 degrees in the 30 degree field was secondary to an unknown cause. In comparison to the affected eyes seventeen eyes with normal visual acuity and no history of optic neuritis were tested by program 31. Results showed that 3 eyes had abnormal points in 10-30 degree sections.
We describe the clinical and pathologic features of experimental allergic neuritis in Lewis rats inoculated with varying doses of myelin, ranging from 0.5 to 20 mg. The clinical scores were assessed daily. On days 18 and 19 or 28 postimmunization, the rats were perfused with fixative and samples of cervical and lumbar roots and sciatic nerves were processed and embedded in Epon. Tissues were examined by light and electron microscopy and the degree of edema, inflammation, demyelination, and axonal degeneration was assessed quantitatively. We found that the severity of clinical and pathologic experimental allergic neuritis correlated positively with the dose of myelin used for immunization. High dose tolerance was not observed. Demyelination prevailed in nerve roots and increased with higher doses of antigen. Accompanying axonal degeneration was seen only with high doses of myelin. The pathology of sciatic nerves differed. Sciatic nerves of rats immunized with 0.5 and 1 mg of myelin were either normal or showed perivenular lymphocytic infiltrates and demyelination, but nerves from rats with higher immunizing doses of myelin showed increasingly severe axonal degeneration. The axonal degeneration in nerve roots paralleled the degree of inflammation and demyelination and may have been a nonspecific product of the inflammatory reaction. However, the much more severe axonal destruction seen in sciatic nerves with high myelin doses was probably due to other pathogenetic mechanisms.