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PubMed1999

[Amiodarone induced retrobulbar neuritis. Clinical case].

We report a 66 years old male, with an ophtalmologic history of long sightedness, admitted to the hospital due to paroxysmal atrial fibrillation crises in the context of a coronary heart disease. He was treated with i.v. amiodarone, receiving a total dose of 6 g in 72 hours. After the third day of treatment, the patient noticed a correction of his long sightedness and 24 h later, he complained of hlurred vision and orbital frontal headache. Visual field examination revealed a concentric retraction of visual field and a centrocecal scotoma in both eyes. Amiodarone was withdrawn and dexametasone treatment was begun. Three days after amiodarone discontinuation, sight improved and visual field returned to normal. Although retrobulbar neuritis has been associated to various drugs, amiodarone has not been considered as a possible agent.

Aged↗
PubMed2000

Response variability in the visual field: comparison of optic neuritis, glaucoma, ocular hypertension, and normal eyes.

PURPOSE: To compare the relationship between sensitivity and response variability in the visual field of normal eyes and eyes with optic neuritis (ON), glaucoma (POAG), and ocular hypertension (OHT). METHODS: Frequency-of-seeing (FOS) data were collected from four visual field locations in one eye of 71 subjects (12 ON, 25 POAG, 11 OHT, and 23 normal), using a constant stimulus method on an Henson 4000 perimeter (Tinsley Instruments, Croydon, UK). At each location, at least 20 stimuli (subtending 0.5 degrees) were presented for 200 ms at six or more intensities above and below the estimated threshold. The mean and SD of the probit fitted cumulative Normal function were used to estimate sensitivity and response variability. Cluster regression analysis was carried out to determine whether there were differences in the sensitivity-log (variability) relationship between the four groups. RESULTS: Variability was found to increase with decreased sensitivity for all four groups. The combined data from the four groups was well represented (R2 = 0.57) by the function log(e)(SD) = A.sensitivity (dB) + B, where the constants A and B were -0.081 (SE, +/-0.005) and 3.27 (SE, +/-0.15), respectively. Including other statistically significant covariates (false-negative errors, P = 0.004) and factors (diagnosis, P = 0.005) into the model increased the proportion of explained variance to 62% (R2 = 0.62). Stimulus eccentricity (P = 0.34), patient age (P = 0.33), fixation loss rate (P = 0.10), and false-positive rate (P = 0.66) did not reach statistical significance as additional predictors of response variability. CONCLUSIONS: The relationship between response variability and sensitivity is similar for ON, POAG, OHT, and normal eyes. These results provide supporting evidence for the hypothesis that response variability is dependent on functional ganglion cell density.

Cell Count↗
PubMed2000

Clinico-immunogenetic characteristics of multiple sclerosis with optic neuritis in children.

The frequency of multiple sclerosis (MS) with clinical onset before 16 years of age in different regions of Russia fluctuates from 2 to 10% of all MS patients. One of the most frequent signs of MS manifestation and/or exacerbation at this age is optic neuritis (ON). Forty-seven children with MS were observed in Moscow. Diagnosis of MS in every case was clinically definite and proved by serial MRI. Clinico-tomographic dissociation was noticed: numerous large lesions, typical for MS on T2 images were often seen in children with mild or moderate residual neurological symptoms. All patients had relapsing/remitting MS course, mean EDSS was 2.24+/-0.26. Thirty-eight children (80%) had ON at least once, ten (21.3%) - twice or more times. In several cases ON had subclinical course or might be missed and the damage of the optic nerve with partial atrophy was found only after complex ophthalmological investigation including visual evoked potentials. Thus, the clinical course of MS and ON have some peculiarities in children and may be genetically based. Analyses of allelic polymorphisms of HLA-DR and TNF loci on chromosome 6 was performed. Data from children with MS were compared with data from their parents, healthy controls and other MS patients from the same ethnic group. Children with MS had increased frequency of DR2(15) and TNF-a11, but not TNF-a9 as adult MS patients from the same ethnic group. The presence of TNF-a7, rare in adult patients, could be proposed as a marker of early MS onset.

Adolescent↗
PubMed2000

[Optic neuritis as the initial manifestation of multiple sclerosis].

Optic neuritis (ON) may be the initial manifestation of multiple sclerosis (MS). We report on a partially retrospective (1960-1984) and longitudinal study (1985-1995) of patients with MS that had earlier ON. The study group (ON + MS) comprised 173 confirmed cases of ON, the control group (MS) included 767 MS patients without history of initial ON. The time lapse from ON to MS was less than 5 years in 128 patients (73.99%), 6-10 years in 37 (21.39%) and more than 10 years in only 8 (4.62%). ON does not affect the course of MS, age at onset, duration of disease or life expectancy. Disability status (EDSS) in both groups was similar although EDSS progression was somewhat slower and the relapse rate per year was lower (0.37) in group ON + MS. We conclude with respect to survival and relapse rate that ON is a prognostically somewhat favorable manifestation of MS.

Acute Disease↗
PubMed1997

The effects of monoamine reuptake inhibiting antidepressants in experimental allergic neuritis.

Experimental allergic neuritis (EAN) is a CD4+ T cell mediated autoimmune disease that is characterized by inflammation and demyelination affecting the peripheral nervous system (PNS). EAN represents an animal model for the study of the immunopathogenesis, immunoregulation and immunotherapy of human Guillain-Barré syndrome (GBS). Although the pathogenesis of EAN remains an enigma, growing evidence points to a possible involvement of an integrated attack by T cells, B cells and macrophages. Th1 related inflammatory cytokines like interferon-gamma (IFN-gamma), tumour necrosis factor-beta (TNF-beta) and TNF-alpha, IL-6 as well as IL-12 could play a major role in the development of tissue damage in EAN. The monoamine reuptake inhibiting antidepressants show immunomodulatory effects on clinical signs and immune response of EAN. The mechanisms behind the suppressive effect of zimeldine, norzimeldine, clomipramine and imipramine on EAN symptoms may include an action on T cell autoreactivities that are directed against myelin proteins. Suppression may be the net result of local accumulation of 5-HT and noradrenalin in regional lymph nodes and peripheral nerves as well as direct and indirect drug effects on cytokine release by peripheral lymphocytes. These antidepressant drugs also exert modulatory effects on MHC class I and II in EAN rat macrophages even in the absence of IFN-gamma. The modulatory effect of antidepressant drugs on IFN-gamma induced MHC class I and II expression may contribute to their influence on demyelinating autoimmune diseases, and may have implications for their clinical use.

Animals↗
PubMed2000

Tracking the recovery of local optic nerve function after optic neuritis: a multifocal VEP study.

PURPOSE: To explore the multifocal visual evoked potential (mVEP) as a technique for tracking local optic nerve damage after unilateral optic neuritis (ON). METHODS: Humphrey visual fields and mVEP recordings were obtained from three patients within 7 days of an episode of ON. Patients were retested during the recovery phase, approximately 4 to 7 weeks later. The multi-input procedure of Sutter was used to obtain 60 local VEP responses (the mVEP) to a scaled checkerboard pattern. The mVEPs were recorded separately for monocular stimulation of both eyes. RESULTS: Initially, all three patients had extensive visual field defects, reduced visual acuity, and depressed mVEP amplitude in regions of poor visual field sensitivity. By 4 to 7 weeks, the fields recovered to near normal sensitivity in most locations, and visual acuity returned to 20/20. The mVEP recovered to nearly full amplitude in all regions, but substantial delays were present in many locations. The delayed responses were associated with regions of visual field loss documented during the acute phase. CONCLUSIONS: The mVEP can be used to track local optic nerve damage after unilateral ON. This technique should be useful in observing the effects of treatments as well as in testing hypotheses about the mechanisms underlying both the acute loss of vision and the subsequent recovery.

Acute Disease↗
PubMed2001

[Acute optic neuritis in children: clinical features and treatment. A study of 28 eyes in 20 children].

PURPOSE: Analyzing a personal series of children with acute optic neuritis (AON), we studied MATERIAL AND METHODS: A retrospective study of 28 eyes in 20 patients (mean age: 10;7 years), examined between 1982 and 1997, with a follow-up ranging from 6 months to 15 years (mean: 5;5 years). We recorded etiologic factors, clinical features (ocular and extra ocular), biological results, and neuroimaging findings. RESULTS: Initial involvement was uni- or bilateral with poor visual acuity (under 20/200 in 22 eyes of 28). Intracerebral inflammation was present in 9 of 13 cases where MRI was performed. We found a cause in only 7 cases (5 viral diseases and 2 recent vaccinations against hepatitis B). Visual recovery was good (over 20/25 in 20 eyes of 28) whatever the treatment, but AON recurred in 5 children. Four children later developed multiple sclerosis. CONCLUSIONS: The cause of AON is rarely found. After eliminating an infection, we retained viral disease, complication of a recent vaccination against hepatitis B, and neurological diseases. MRI was the imaging study of choice. Development of multiple sclerosis occurred in 4 cases of 20, the same frequency as in the literature. The risk of later development of multiple sclerosis was 20%. Progression of AON was often excellent. Nevertheless, corticotherapy was added, in form of intravenous boluses followed by decreasing oral therapy for one month.

Acute Disease↗
PubMed2001

[Anterior optic neuritis do to ulcerative colitis].

PURPOSE/METHODS: We present the case of a 27 year old woman with acute bilateral loss of vision associated with abdominalgia, bloody diarrhea and arthralgia. In the present article, the different forms of ocular complications in relationship to chronic intestinal inflammations and their possible causes are discussed. RESULTS/CONCLUSIONS: On examination, bilateral anterior uveitis associated to a picture of optic nerve lesion compatible with a bilateral anterior optic neuritis was observed. The patient was diagnosed of ulcerative colitis by intestinal biopsy. The ocular affectation resolved after the ulcerative colitis was treated with systemic mesalamine.

Adult↗
PubMed2001

[Retroperitoneal fibrosis associated with neuritis symptomatology due to external iliac artery stent subadventitial migration].

The occurrence of a neuritis of the ischiatic nerve and the genito-femoral nerve due to the implant of three stents in the iliac artery, is an extremely rare complication, especially if associated with retroperitoneal fibrosis which caused a nevritis symptomatology. A case of stent migration in the subadventitial space which caused 4 years from angioplasty and stents implant, a nevritis symptomatology. Retroperitoneal fibrosis has been considered as a consequence of the stents presence and of their chronic irritational activity, especially for what concerns the stent migrated in the subadventitial space; the procedure personally performed in this case is reported.

Foreign-Body Migration↗
PubMed1975

Serial nerve conduction and electromyographic studies in experimental allergic neuritis.

Experimental allergic neuritis (EAN) was produced in ten guinea pigs by intradermal injection of peripheral nerve antigen and complete Freund's adjuvant. Six additional animals were injected with adjuvant only, and three control animals received saline. Slowing of motor nerve conduction velocity occurred in all animals ijected with antigen. Velocities progressively decreased through the first six weeks, at which time they started increasing, returning to the normal range in the third month. Six of the animals--generally those having received the greatest amount of antigen and adjuvant--developed severe encephalomyelitis and died early in the study. These animals also developed more severe peripheral nerve involvement, and conduction velocities decreased more than in mildly affected animals. Abnormal electromyographic findings were observed in all EAN animals surviving through the third week. Two of the six animals injected with complete adjuvant without antigen showed some minimal electromyographic changes. Several developed slight slowing of nerve conduction velocity during the first few weeks. Saline control animals had normal nerve conductions and electromyographic studies throughout the course of observation.

Animals↗
PubMedDate not supplied

[A variant form of septo-optic-pituitary dysplasia (SOPD) complicated with acute optic neuritis].

We herein report a case of a variant form of septo-optic-pituitary dysplasia (SOPD). A 40-year-old man was admitted due to sudden occurrence of left blurred vision and lasting polyuria. He showed short statue of height of 144 cm and the neurological examination revealed hypesthesia of the left trigeminal nerve and temporal pallor in the left fundus oculi. Brain MR imaging demonstrated agenesis of the septum pellucidum and hypoplasia of the corpus callosum with subcortical spotty lesions, but optic nerve hypoplasia was not detected. The left eye showed a prolonged P100 latency of pattern reversal VEPs. He was diagnosed as having hypopituitarism since growth hormone-releasing factor did not stimulate growth hormone secretion and restriction of water-intake did not induce secretion of antidiuretic hormone. Thus we regarded this case as a variant form of SOPD. The mutation of HESX 1 gene, however, was not detected in the case. P100 of the left eye showed a reduction in latency four months after discharge. This case was considered to be a variant form of SOPD complicated by acute optic neuritis.

Acute Disease↗
PubMed2000

Screening for mt-DNA mutations in optic neuritis of unknown cause.

OBJECTIVE: To investigate mitochondrial DNA (mt-DNA) mutations in optic neuritis of unknown cause (ONUC) and to assess the practical value of mt-DNA mutation detection in etiologically and differentially diagnosing ONUC. METHODS: Thirty patients with ONUC were screened for mt-DNA mutations of nt11778, nt3460 and nt15257 by using SSCP, mutation-specific primer PCR and sequencing. RESULTS: mt-DNA mutations were found in twelve of thirty ONUC patients. All of the mutations were at nt11778 position, but no one at nt3460 and nt15257. CONCLUSIONS: Forty percent (12/30) of ONUC patients were caused by an mt-DNA mutation. Combined with other routine measures, screening for mt-DNA mutations in ONUC patients is of great significance in diagnosing ONUC etiologically and differentially.

Adolescent↗
PubMed2000

Treatment of rats with experimental allergic neuritis using high dose immunoglobulin.

OBJECTIVE: To investigate the therapeutic potential of high-dose immunoglobulin (HIG) in experimental allergic neuritis (EAN) to provide a theoretical basis of its clinical use in the treatment of human inflammatory demyelinating neuropathies. METHODS: Female Lewis rats were induced to EAN, and divided into experimental and control groups. The rats were treated with either 0.3 g/kg.day-1 of IgG or an equivalent volume of 0.15 mol/L glycine. Clinical, electrophysiologic, and histologic evaluations were carried out in a blind fashion. RESULTS: Clinically, rats treated with IgG had significantly less severe symptoms (P < 0.001) and slower progression (P < 0.001) than controls. Electrophysiologically, the mean conduction latency of the experimental group was significantly shorter than controls (P < 0.05). Histologically, rats treated with IgG prepared from normal Lewis rats had a significantly lower percentage of demyelinated fibers (P = 0.01) and total abnormal fibers (P < 0.001) than controls. Statistically, clinical, electrophysiologic and morphologic data were all significantly correlated. CONCLUSIONS: The EAN animal model is reliable for observation of HIG effects, and useful to provide data for clinical work. HIG has a significant therapeutic effect in EAN when given soon after disease onset. It can reduce clinical disease severity and decrease the number of demyelinated fibers as well as the number of total abnormal fibers. For the current controversy over whether HIG is effective, the results of this research support the clinical use of HIG in human demyelinating neuropathy.

Animals↗
PubMedDate not supplied

[Role of ultrasonic B-scanning in differential diagnosis and prognosis of the course of optic neuritis].

The possibility of using ultrasonic scanning in differential diagnosis of optic neuritis (ON) and anterior ischemic neuropathy (AIN) and the prognostic significance of the results were evaluated. The thickness of retrobulbar part of the optic nerve directly behind the eye was measured by echographic B method in patients with ON and AIN. The thickness of the retrobulbar part of the involved and paired optic nerve was more than 0.7 mm in 90% patients with ON, which can be considered as an additional clinical sign of ON. Thickening of the retrobulbar part of the optic nerve is not characteristic of AIN. In patients with disseminated sclerosis ON is associated with less pronounced thickening of the retrobulbar part of the optic nerve than in idiopathic ON, which agrees with the pathogenesis and pathomorphology of disseminated sclerosis. The degree of optic nerve thickening in ON in patients with disseminated sclerosis is prognostically insignificant, while in idiopathic ON more than 2 mm asymmetry of the retrobulbar part of the involved and paired optic nerve is a sign predicting a long course of the disease and maybe incomplete recovery of vision. Thickening of the involved optic nerve by less than 1.7 mm is associated with a better prognosis as regards the time and completeness of vision restoration.

Adult↗
PubMed2002

[Acute optic neuritis: clinical and MRI prognostic factors. Study of fifty patients].

The objective of this study was to evaluate the risk of visual outcome after acute optic neuritis (ON) in relation to clinical and MRI findings. Fifty cases of acute ON within one month were retrospectively studied. MRI with Short Tau Inversion Recovery (STIR) sequence of the optic nerve were obtained with a median time onset of 9 days after ON. Mean age of patients was 32.8 years, mean initial visual acuity was 3/10 and orbital pain was present in 86 percent100 of patients. The STIR sequence revealed lesion in 88 percent 100 of acutely symptomatic optic nerves. An initial low visual acuity (less than 2/10), the absence of orbital pain and involvement of the intracanalicular portion of the optic nerve on STIR sequence were statistically correlated with a poorer visual outcome (respectively p=0.0041, p=0.035 and p=0.011).

Acute Disease↗
PubMed2002

[Transcranial duplex scanning in estimation of cerebral hemodynamics in patients with secondary cochleovestibular neuritis].

The authors present pilot experience with transcranial duplex scanning (TCDS) of the cerebral vessels in 17 patients with secondary cochleovestibular neuritis combined with chronic leptomeningitis (primarily of the posterior cranial fossa). This method has determined extra- and intracranial hemodynamics, characterized arterial and venous blood flow qualitatively and quantitatively, outlined possible genetically determined factors in development of dyscirculatory disorders. Finally, hemodynamic defects of two types were revealed in 12 patients. Type 1 (3 patients) was characterized by asymmetric circulation in the territory of the middle, anterior and posterior cerebral arteries, by the absence of venous congestion. Type 2 (9 patients) was characterized by impaired venous outflow manifesting as higher speed of the blood flow and its phase response along the intracranial veins and sinuses. In 7 patients these defects combined with asymmetric circulation along brain stem arteries. These patients were diagnosed to have perilymphatic labyrinthine hydrops.

Adult↗
PubMed1975

[Partial closure of the central artery and vein of the retina in retrobulbar optic neuritis (author's transl)].

The changes in the fundus of a 57-year-old patient (perimacular turbid retinal oedema, cloudy peripapillary exsudates and peripheral retinal hemorrhages) could not be interpreted satisfactorly on a clinical basis. Histologic examination revealed a retrobulbar optic neuritis associated with round cell infiltrates around the central retinal blood vessels impeding their blood flow.

Fluorescein Angiography↗
PubMed1999

[Apoptosis of CD4(+) T cells during experimental autoimmune neuritis in Wistar rats].

The present study describes apoptosis of T cells in the sciatic nerve in Wistar rats with experimental autoimmune neuritis(EAN). Morphological characterizations of apoptosis were found at the 18th day from onset, peaked at the 22nd day by immunocytochemical analysis. In situ end labeling(ISEL) techniques confirmed the presence of DNA fragmentation in CD4(+) T cells. It is suggested that apoptosis is an important clearance mechanism of infiltrated T cells in the peripheral nervous system(PNS) in EAN.

Animals↗