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PubMed1985

Two common neuro-ophthalmic problems. Optic neuritis and transient visual disturbances.

Optic neuritis and transient visual disturbances are common and challenging neuro-ophthalmic problems. Optic neuritis may occur during the course of several neurologic and systemic disorders and is characterized by reversible central visual loss. In many patients, signs and symptoms of multiple sclerosis occur after an episode of optic neuritis. Although several risk factors for development of multiple sclerosis have been identified, the relationship between optic neuritis and multiple sclerosis is still controversial. Transient visual disturbances may take the form of visual loss or visual hallucinations. In many cases, the cause of transient visual loss is never found. Hallucinations of ocular origin, however, are easily diagnosed by a thorough eye examination.

Antibodies, Viral↗
PubMed1997

Does optic disc appearance distinguish ischemic optic neuropathy from optic neuritis?

OBJECTIVE: To determine whether characteristics of optic nerve swelling assist in distinguishing between optic neuritis and anterior ischemic optic neuropathy. METHOD: Optic nerve stereophotograph review by masked observers. RESULTS: Altitudinal swelling, pallor, arterial attenuation, and hemorrhage are found more commonly in anterior ischemic optic neuropathy than in optic neuritis. CONCLUSION: Optic disc appearance does help to distinguish anterior ischemic optic neuropathy from optic neuritis, although there are overlapping features.

Acute Disease↗
PubMed1992

Correlation of magnetic resonance imaging and CSF findings in patients with acute monosymptomatic optic neuritis.

Acute monosymptomatic optic neuritis (AMON) may be the first indication of multiple sclerosis (MS), and this sign offers a special opportunity to study the very early clinical stages of MS. This prospective investigation compares results of CSF findings and magnetic resonance imaging (MRI) in a large, homogeneous and well-defined group of patients with AMON. Of 68 consecutively referred patients, 11 had clinically definite MS, another 5 refused a lumbar puncture, and 7 could not participate for various reasons. With the remaining 45 untreated patients, aged 12-52 (mean 31) years, with idiopathic AMON, we have studied interrelationships of CSF findings (leucocyte count, IgG-index and in 29 of the patients oligoclonal bands (OB)) and MRI. Lumbar puncture and MRI were performed within median 24 and 16 days of onset, respectively. In the CSF one or more abnormalities (in 17/45 = 38% pleocytosis, in 16/45 = 36% increased IgG-index, and in 20/29 = 69% OB) was found in a total of 23/29 = 79% of patients. MRI at 1.5 T (double SE and IR sequences) showed multiple cerebral lesions in 65% of patients. A significant relation was observed between results of MRI and leucocyte count (p < 0.05) and between results of MRI and IgG-index (p < 0.05), but not between results of MRI and OB (p > 0.20). Over a median observation period of 27 months, 13 patients developed clinically definite MS. All of these patients had lesions on MRI at onset, illustrating the prognostic importance of MRI findings. Results of CSF had until now no marked predictive value for developing clinically definite MS.

Adolescent↗
PubMed1994

[Rhinogenous retrobulbar optic neuritis: a case report].

Rhinogenous retrobulbar optic neuritis is characterized by neuritis secondary to paranasal sinusitis. A case of rhinogenous retrobulbar optic neuritis that was successfully treated by surgery is reported. A 40-year-old man complained of progressive right visual disturbance. The clinical course and neurological examination suggested right retrobulbar optic neuritis. CT and MRI scans demonstrated a massive tumor-like lesion near the right optic canal. Fifteen days after the onset, decompression of the right optic nerve was performed using a right pterional approach. After surgery, visual disturbance improved, and after about 1 month, the symptom had disappeared. Operative findings, histological examination and the postoperative course were consistent with the characteristics of rhinogenous retrobulbar optic neuritis. We consider decompression of the optic nerve to be effective for the treatment of rhinogenous retrobulbar optic neuritis.

Adult↗
PubMed2000

Progression of visual evoked potential abnormalities in multiple sclerosis and optic neuritis.

To investigate visual signal processing in patients with optic neuritis, suspected multiple sclerosis, confirmed multiple sclerosis (MS), and optic neuritis combined with MS, pattern reversal visual evoked potentials (VEPs) were recorded in patients and normal subjects. The amplitude and latency of the first positive peak, P100 were determined to assess electrical conduction in patients as compared to normal subjects. Suspected MS patients did not differ from normal subjects in peak latencies or amplitudes. The P100 amplitude was reduced in optic neuritis, confirmed MS and optic neuritis combined with confirmed MS. The P100 and N145 latencies were prolonged in optic neuritis patients and confirmed MS patients as compared to normal subjects. The main characteristic of optic neuritis was P100 amplitude reduction, and of confirmed MS was P100 latency delay. There was a progression of the P100 latency delay and of the P100 amplitude decrement in optic neuritis, confirmed MS, and optic neuritis combined with confirmed MS. These results indicate a progression of demyelination in optic neuritis, confirmed MS, and optic neuritis combined with confirmed MS.

Adolescent↗
PubMed2005

Reactive Lyme serology in optic neuritis.

BACKGROUND: Establishing a causal relationship between optic neuritis and Lyme disease (LD) has been hampered by technical limitations in serologic diagnosis of LD. Even so, there is a general impression that optic neuritis is a common manifestation of LD. METHODS: Retrospective case analysis of Lyme serology in 440 patients with optic neuritis examined between 1993 and 2003 in a single neuro-ophthalmic practice at Stony Brook University Medical Center, Suffolk County, New York, a region hyper-endemic for LD. RESULTS: Lyme enzyme-linked immunosorbent assay (ELISA) was positive in 28 (6.4%) patients with optic neuritis, three of whom had syphilis with cross-reactive antibodies. Among the remaining 25 ELISA-positive patients, optic neuritis could be confidently attributed to LD in only one case, a patient with papillitis. The other 24 cases had reactive Lyme serologies related to a history of LD years earlier, asymptomatic exposure, false-positive results, or non-specific humoral expansion. The ELISA in these 24 cases were weakly positive and the Western blots were negative by Centers for Disease Control criteria. There were no significant clinical differences between the 25 seropositive optic neuritis cases and 50 seronegative optic neuritis cases. CONCLUSIONS: Based on these cases and a review of the literature, there is insufficient evidence for a causal link between LD and retrobulbar optic neuritis or neuroretinitis. There is sufficient evidence to establish a causal link between LD and papillitis and posterior uveitis.

Adolescent↗
PubMed2004

Neurologic impairment 10 years after optic neuritis.

BACKGROUND: Participants enrolled in the Optic Neuritis Treatment Trial have been observed for more than a decade to assess the relationship between optic neuritis and the development of clinically definite multiple sclerosis. OBJECTIVE: To assess neurologic disability 10 to 12 years after an initial episode of optic neuritis. DESIGN: Longitudinal follow-up of a clinical trial. SETTING: Fourteen Optic Neuritis Treatment Trial clinical centers performed standardized neurologic examinations, including an assessment of neurologic disability. PARTICIPANTS: One hundred twenty-seven patients who had developed clinically definite multiple sclerosis. MAIN OUTCOME MEASURES: Functional Systems Scale and Expanded Disability Status Scale. RESULTS: The disability of most patients was mild, with 65% of patients having an Expanded Disability Status Scale score lower than 3.0. The degree of disability appeared to be unrelated to whether the baseline magnetic resonance imaging scan was lesion-free or showed lesions (P =.51). Among patients with baseline lesions, the degree of disability was unrelated to the number of lesions that were present on the scan (P =.14). Two patients died owing to severe multiple sclerosis, one of whom had no lesions revealed on the baseline scan. CONCLUSION: Most patients who develop clinically definite multiple sclerosis following an initial episode of optic neuritis will have a relatively benign course for at least 10 years.

Adult↗
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↗
PubMed1997

[Optic neuritis and measles infection].

Optic neuritis has been reported as a complication of measles encephalitis. This resembles to parainfectious optic neuritis following other virus infections. We mentioned pathology, therapy of this disease, and summarized our previous cases. Intravenous methylpredonisolone treatment is effective from our experience.

Adolescent↗
PubMedDate not supplied

Optic neuritis in herpes zoster ophthalmicus.

BACKGROUND: Optic neuritis in herpes zoster ophthalmicus (HZO) has been reported rarely. We report two cases of HZO optic neuritis with detailed magnetic resonance imaging study and treatment responses. CASES: One patient presented with anterior optic nerve involvement, and the second presented with retrobulbar optic neuritis. Contrast enhanced T(1)-weighted images were obtained in these 2 patients. Intravenous acyclovir and oral prednisolone were given simultaneously. OBSERVATIONS: Magnetic resonance imaging revealed peripheral enhancement of the optic nerve sheath complex on T(1)-weighted scan. Both patients recovered their vision within 3 months following the start of treatment. CONCLUSIONS: Magnetic resonance imaging is helpful for the diagnosis of HZO optic neuritis. Systemic acyclovir and steroid are effective in the treatment of HZO optic neuritis.

Acyclovir↗
PubMed1991

Impaired critical flicker frequency in recovered optic neuritis.

Thirteen patients with optic neuritis who recovered normal visual acuity and kinetic perimetry all showed impairment of foveal critical flicker frequency, a psychophysical test of visual temporal resolution. Because the magnocellular visual system demonstrates higher temporal resolution than the parvocellular system, this finding implicates involvement of axonal projections of magnocellular retinal ganglion cells in recovered optic neuritis.

Adolescent↗
PubMed1984

Acute and chronic experimental optic neuritis. Alteration in the blood-optic nerve barrier.

Horseradish peroxidase (HRP) tracer studies in experimental allergic optic neuritis showed alterations in the blood-optic nerve barrier. Light and electron microscopic examination of the optic disc disclosed intense leakage of HRP at the lamina scleralis, with extracellular staining of both axonal and glial columns, despite the lack of inflammation at this region. The intraorbital optic nerve showed leakage of HRP at the sites of both acute and chronic demyelination. Ultrastructurally, leakage of HRP was confined to the perivascular and extracellular spaces. The mechanism of leakage seems to be by diffusion through the endothelial cell junctions or vesicular transport across the endothelial cells. The high predilection for involvement of the optic nerve in chronic demyelinating disorders may be due to the inherent weakness of the blood-brain barrier at the optic nerve head.

Animals↗
PubMed2001

Management of optic neuritis and multiple sclerosis.

Optic neuritis and multiple sclerosis (MS) are common causes of visual and neurologic dysfunction in young adults. Advances in magnetic resonance imaging, molecular genetics, and neuroimmunology have increased our understanding of the pathophysiology underlying both disorders. Corticosteroids remain the mainstay of treatment of optic neuritis, but alternate dosages and routes of administration are undergoing investigation. The available therapies for MS have expanded, and there is evidence that early intervention is beneficial. Treatments for MS show sustained efficacy, but are not curative, and adjunctive treatments may prove valuable in patients with progressive visual and neurologic disability.

Humans↗
PubMed1999

Coronaviruses in spinal fluid of patients with acute monosymptomatic optic neuritis.

UNLABELLED: Acute monosymptomatic optic neuritis (AMON) may be an initial symptom of multiple sclerosis (MS). Coronaviruses have been implicated in the etiology of MS. The objective of the present study was to look for coronaviral RNA in AMON, which could be present in the initial stages of the development of MS. MATERIAL AND METHODS: Spinal fluids from 37 patients with AMON and 15 surgical control patients with protrusion of the intervertebral disk were assayed with a nested multiplex polymerase chain reaction with primers specific for human coronaviruses strain (HCV) 229E and OC43. RESULTS: Four patients and 1 control were positive for HCV-229E. No evidence of HCV-OC43 was found. The frequency of positive samples was low and there was no statistical difference between AMON and controls. CONCLUSION: This study does not provide evidence for an etiological role of human coronaviruses in acute monosymptomatic optic neuritis.

Acute Disease↗
PubMed2006

The clinical features, MRI findings, and outcome of optic neuritis in children.

BACKGROUND: Optic neuritis (ON) in childhood is thought to be more likely bilateral and less likely to lead to multiple sclerosis (MS) vs ON in adults. METHODS: The authors evaluated clinical features, maximal visual deficit and recovery, visual evoked potentials (VEPs), neuroimaging, and outcome in a cohort of children with ON. RESULTS: Records of 36 children (female/male ratio 1.6), ages 2.2 to 17.8 (mean 12.2) years, were reviewed. ON was unilateral in 58% and bilateral in 42%. Maximal visual deficit was severe in 69%, but full recovery occurred in 39 of 47 affected eyes (83%). VEPs were abnormal in 88%. Neurologic abnormalities in addition to those associated with ON were documented in 13 children. Neuroimaging studies of the optic nerve were abnormal in 55%. Brain MRI in 35 children demonstrated white matter lesions separate from the optic nerves in 54%. Follow-up is 2.4 years (0.3 to 8.3 years). To date, 13 children (36%) have been diagnosed with MS and 1 has Devic disease. Bilateral ON was more likely to be associated with MS outcome (p = 0.03). All 13 children with MS had white matter lesions on brain MRI. None of the children with a normal brain MRI have developed MS to date. CONCLUSIONS: Contrary to expectations, optic neuritis (ON) in childhood was more likely to be unilateral, multiple sclerosis (MS) risk was high (36% at 2 years), and bilateral rather than unilateral ON was associated with a greater likelihood of MS. Clinical findings extrinsic to the visual system on baseline examination (p < 0.0001) and MRI evidence of white matter lesions outside the optic nerves (p < 0.0001) were strongly correlated with MS outcome.

Adolescent↗
PubMed1985

Anti-myelin basic protein antibody in experimental allergic optic neuritis and encephalomyelitis.

We produced demyelinating optic neuritis and encephalomyelitis in juvenile strain 13 guinea pigs by sensitization with optic nerve myelin. Three distinct clinical courses were noted: a severe, acute optic neuritis associated with a rapidly fatal encephalomyelitis; a mild, chronic optic neuritis with a nonfatal encephalomyelitis; and an initially mild disease followed by an acute exacerbation of optic neuritis and fatal encephalomyelitis. Clinically mild disease was associated with elevated levels of anti-myelin basic protein antibody, while severe disease was associated with extremely low antibody levels.

Animals↗