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At least 145 records · Page 8Linked to original sources
PubMed2000

Reactional states and neuritis in multibacillary leprosy patients following MDT with/without immunotherapy with Mycobacterium w antileprosy vaccine.

A vaccine based on autoclaved Mycobacterium w was administered, in addition to standard multidrug therapy (MDT), to 157 untreated, bacteriologically positive, lepromin negative multibacillary leprosy patients, supported by a well matched control group of 147 patients with similar type of disease, who received a placebo injection in addition to MDT. The MDT was given for a minimum period of 2 years and continued until skin smear negativity, while the vaccine/placebo was given at 3-monthly intervals up to a maximum of eight doses. The incidence of type 2 reaction and neuritis during treatment and follow-up showed no statistically significant difference in the vaccine and placebo groups. The incidence of type 1 reaction (mild in most cases), however, was higher in the vaccine group (P = 0.041, relative risk ratio 1.79), considering LL, BL and BB leprosy types together, and considerably higher (P = 0.009) in LL type, probably because of confounding due to higher number of patients with previous history of reaction in this group. The occurrence of reactions and neuritis in terms of single or multiple episodes was similar in the vaccine and placebo groups. The association of neuritis and reactions, as well as their timing of occurrence (during MDT or follow-up), was also similar in the two groups, with more than 90% of occurrences taking place during MDT. The incidence of reversal reaction was significantly higher among the males in the vaccine group (34.5% versus 8.3%, P = 0.019). Patients with high initial BI (4.1-6.0) showed higher incidence of reactions (70.3%) as compared to those with medium (2.1-4.0) and low (0.3-2.0) BI where the reactions were observed with a frequency of 56.1% and 38.8%, respectively. However, unlike reactions, neuritis incidence did not seem to be affected by initial BI to the same extent in the vaccine group, with frequencies of 35.3%, 36.3% and 25.9% in the three mentioned BI ranges. Overall, the vaccine did not precipitate reactional states and neuritis over and above that observed with MDT alone.

Bacterial Vaccines↗
PubMed1999

[Magnetic resonance imaging in 40 cases of optic neuritis].

OBJECTIVE: To explore the clinical value of magnetic resonance imaging (MRI) in optic neuritis. METHODS: Forty patients with optic neuritis were examined with the spectral presaturation inversion recovery and fluid attenuated inversion recovery. RESULTS: The lesion was frequently seen in orbital portion (86.7%) and intracanalicular portion (29.3%), and primarily in the axial part (49.3%) and transverse section (38.7%) of the optic nerve. The longitudinal extent of lesion was from 2 to 35 mm (mean, 12.6 mm), the visual acuity of patients with optic neuritis was related to the site of the lesion, and negatively correlated with the longitudinal extent of lesion of logarithm curve. A poor visual acuity (< 0.01) was significantly associated with lesion of greater extent > 10 mm and the transverse or axial lesion, but the good visual acuity (>or= 0.3), with the lesion of smaller extent < 10 mm and the axial or peripheral lesion. In addition, paramagnetic contrast-medium, Gd-DTPA, enhancement scanning was carried out in 11 cases of optic neuritis, of them the visual acuity was increased in 10 cases after administration of corticosteroid, and in one case, visual improvement was not seen. CONCLUSION: MRI is a new and useful equipment which is helpful in the diagnosis and treatment of optic neuritis.

Adolescent↗
PubMedDate not supplied

[Clinical characteristics of optical neuritis in children].

OBJECTIVE: To describe the clinical characteristics and the visual prognosis of a group of children affected with optic neuritis. PATIENTS AND METHODS: The clinical charts of patients under 15 years of age with clinical criteria of optic neuritis were revised at the Hospital Universitario San Vicente de Pa l (Medell n, Colombia), in a time span from January 1th 1989 to December 31th 2001. RESULTS: 16 patients fulfilled the clinical criteria of optic neuritis; 50% were male and the overall mean age was 9,4 years. Seven (43,7%) patients had a preceding infectious disease two weeks earlier and only one suffered from varicella four weeks earlier. Decrease in visual acuity was present in 15 (94%) patients; 7 (44%) had headache; 7 (44%) had ocular ache and 25% had both, head and ocular ache. Neuritis was found in 28 eyes, of whom 68% had papilledema and in 32% the fundoscopic examination was normal. Bilateral affection was present in 75%. Excellent visual prognosis (20/20) was present in 19 (68%) of affected eyes; good (20/20 to 20/50) in 4 (14%), regular (20/50 to 20/100) in 2 (7%) and bad (20/200) in 11%. CONCLUSION: In our country the clinical evolution of childhood optic neuritis does not differ from that reported in other parts of the world.

Adolescent↗
PubMed2005

Diagnostic and therapeutic doubts in retrobulbar neuritis in children.

Retrobulbar neuritis is often very complicated clinical entity. The most common cause of retrobulbar neuritis is demyelinating disease of CNS. This report is to express some other uncommon causes of it. Three children, age 8 to 12 with sudden and severe visual loss are presented. The diagnosis of retrobulbar neuritis is made by complete ophtalmological examination in consultation with neuropediatrics and neuroradiologist. Different ethiological causes of retrobulbar neuritis are found: pranasal sinusitis, functional visual loss and pseudotumor cerebri. In first two children complete therapeutically effort was as expected, and by child with pseudotumor cerebri there was no improvement of visual acuity, even after 6 months. In this presentation the authors want to emphasise some uncommon causes of retrobulbar neuritis.

Child↗
PubMed2006

The natural history of optic neuritis.

Optic neuritis is a common cause of visual loss in young patients, typically presenting with painful monocular visual loss and decreased color vision. Visual function generally spontaneously improves over weeks, and 95% of patients return to visual acuity of at least 20/40 within 12 months. The initial magnetic resonance imaging (MRI) helps stratify the risk of multiple sclerosis (MS) in patients with acute isolated optic neuritis. In the Optic Neuritis Treatment Trial, the 10-year risk of MS in the group of patients with at least one MRI T2 lesion was 56%, whereas the 10-year risk with a normal baseline MRI was 22%. A normal MRI in concert with painless optic neuritis, severe optic nerve head edema, peripapillary hemorrhages, or a macular star defines a very low MS risk subgroup. High-dose steroids hasten the rate, but not the final extent, of visual recovery in optic neuritis, and the decision to use this therapy is individualized. Interferon beta-1a therapy should be considered in selected high-risk patients.

Disease Progression↗
PubMed1990

[A clinico-immunogenetic method of prognosis in retrobulbar neuritis as an initial manifestation of multiple sclerosis].

Examination of 166 patients with optic neuritis revealed that 65 of them developed multiple sclerosis (MS) at different times after optic neuritis. The observation period was 9.4 years on the average. Using the clinical, laboratory, immunogenetic methods the clinico-immunogenetic heterogeneity of optic neuritis was discovered, the highly informative specific clinical signs and immunogenetic markers suitable as criteria for predicting different variants of optic neuritis outcomes were defined. Using a heterogeneous successive procedure a method of individual ++pre-nosological prediction of MS in persons with a history of optic neuritis was devised.

Adolescent↗
PubMed1987

[Pattern reversal VEP and computer perimetry of the partner eye in optic neuritis].

The pattern-reversal VEP with different check size and the computerized perimetry in the 10 degrees and 30 degrees radius field were recorded in 22 patients suffering from unilateral optic neuritis diagnosed by historical as well as by clinical findings. During the acute attack 12/22 optic neuritis eyes and 3/22 partner eyes had a diminished visual acuity below 0.7. After the attack the visual acuity remained reduced in 9/22 of the affected and 2/22 of the nonaffected partner eyes. The VEP was prolonged in 19/22 optic neuritis eyes and in 12/22 partner eyes applying 50' checks and in 15/22 resp. applying 15' checks. The computed visual fields showed depressions in 21/22 optic neuritis-eyes and in 15/22 partner eyes within in the 30 degrees radius field. VEP and computerized perimetry, there for, can detect subclinical affections of partner eyes in unilateral optic neuritis in a very high percentage.

Computers↗
PubMed1993

Critical flicker frequency in acute and recovered optic neuritis.

Multiple occasional changes in critical flicker frequency (CFF) were studied in patients who recovered from optic neuritis. Twenty-five patients (31 affected eyes) with onset visual acuity less than 0.5 and who showed recovered visual acuity exceeding 1.0 were included in this study. Recovery stages were determined individually as follows: T1, initial onset stage; T2, intermediate stage; T3, recovered stage when visual acuity was 1.0 or better; and T4, final follow-up stage. CFF was determined using red, yellow and green illuminated targets in a compact CFF measuring device recently developed at our department. The rates of abnormality were 100% at stage T1 for all colors, and gradually decreased as the stage advanced from T2 to T4. However, the rates of abnormality continued to be high at 67% in stage T3 for the red target and 37% in stage T4 for the red target. The rates of abnormal interocular difference in CFF in 15 unilateral optic neuritis patients were 100% for all colors at stage T1 and decreased gradually with recovery. Slight but definite abnormality of CFF was also noted in the silent eyes of clinically unilateral optic neuritis patients. The rates of abnormal CFF more than 7% in all colors could be detected in T1, T3 and T4. These results indicate that CFF abnormality can be detected even at the stage of recovery in the pathologic eyes and the fellow eyes of optic neuritis patients. CFF was also shown to be a sensitive indicator for detecting visual dysfunction in patients with optic neuritis.

Acute Disease↗
PubMedDate not supplied

[Usefulness of EEG examination in the diagnosis of multiple sclerosis with particular reference to its prognostic importance in retrobulbar neuritis].

It is known from literature that 40-60% of eeg recordings from SM patients show changes. These changes are: slow generalised activity, focal changes, and sharp waves and spikes occurring in bursts. It is established that optic neuritis often precedes the occurrence of neurological focal changes in SM. The goal of this work was the analysis of eeg recordings from SM patients before and after treatment during disease exacerbation and from patients with optic neuritis without neurological changes. Eeg recordings in optic neuritis showed changes similar to those observed in SM. Follow-up studies proved that patients with changes in eeg during neuritis were at a risk group; absence of such changes does not exclude the possibility of SM. Patients after neuritis should periodically undergo neurological examination.

Adolescent↗
PubMed1996

[Retrobulbar neuritis--diagnosis and differential diagnosis].

The American multicenter study 'A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis' (5) showed how a retrobulbar neuritis should not be treated, Oral steroids (1 mg per kilogram of body weight per day) are not only ineffective but also associated with a higher rate of recurrences compared to high dose i.v. methylprednisolone. In the light of this study, 'low-dose' steroid therapy for retrobulbar neuritis is contraindicated. High-dose methylprednisolone speeds up recovery of the visual function and lowers the recurrence rate two years after treatment; however, this protective effect could not be demonstrated after three years. These recommendations are valid only for primary demyelinating retrobulbar neuritis. Other less common optic neuropathies, such as these of microvascular origin, respond to 'low-dose' steroids; therefore, the diagnosis of primary demyelinating retrobulbar neuritis must be made with caution as a diagnosis of exclusion. This paper discusses a number of important optic neuropathies and gives recommendations for investigations. Compressive optic neuropathies and chiasmal disease will not be covered here.

Central Nervous System Diseases↗
PubMed2004

Acute vestibular neuritis visualized by 3-T magnetic resonance imaging with high-dose gadolinium.

Sudden idiopathic unilateral loss of vestibular function without other signs or symptoms is called acute vestibular neuritis. It has been suggested that reactivation of human herpes simplex virus 1 could cause vestibular neuritis, Bell palsy, and sudden unilateral hearing loss. Enhancement of the facial nerve on gadolinium-enhanced magnetic resonance imaging (MRI) is a common finding in Bell palsy, but enhancement of the vestibular nerve has never been reported in acute vestibular neuritis. We present 2 consecutive cases of acute vestibular neuritis where high-field-strength MRI (3.0 T) with high-dose (0.3 mmol/kg of body weight) gadolinium-pentetic acid showed isolated enhancement of the vestibular nerve on the affected side only. These findings support the hypothesis of a viral and inflammatory cause of acute vestibular neuritis and might have implications for its treatment.

Aged↗
PubMed2001

Absence of nystagmus during REM sleep in patients with vestibular neuritis.

Saccades, including fast phases of nystagmus, disappear during drowsiness and non-rapid eye movement (NREM) sleep, but are present during the alert state and REM sleep. The purpose of this study was to determine whether spontaneous nystagmus is present in patients with vestibular neuritis during REM sleep. Eight patients with spontaneous nystagmus due to vestibular neuritis and eight control patients without any nystagmus underwent at least one night of polysomnography. Fast phases of nystagmus were analyzed. The number of right and left horizontal saccades were counted, first during 3-5 minute samples of the awake state before sleep onset, then during the first REM episode and the last REM episode of nocturnal sleep, and finally during the alert state in the morning after nocturnal sleep. All patients with vestibular neuritis showed significantly more saccades (fast phases) towards the side contralateral to their vestibular lesion in the awake state before and after the polysomnography. This reflects their spontaneous nystagmus. By contrast, during REM sleep the patients with vestibular neuritis showed no preponderance in saccade direction. The eye movement pattern in REM was the same for patients and controls. In conclusion, peripheral vestibular imbalance producing nystagmus in vestibular neuritis in the awake state is not active at the brain stem level during REM sleep.

Aged↗
PubMedDate not supplied

Incidence of neuritis among paucibacillary leprosy patients during treatment and surveillance.

A cohort study was done on 180 patients receiving the standard WHO PB-MDT regimen at the TLM Hospital in Kolkata, during MDT and 2 years of surveillance to determine the incidence of neuritis. Neuritis occurred in only 2 out of the 180 patients, confirming that the current WHO treatment for PB-MDT is attendant with minimal risk of neuritis. No risk factors were found, except pregnancy in a female patient. While addition of clofazimine in the new U-MDT under trial might take care of the occasional neuritis, further clinical research might be useful to identify sub-groups of PB patients at risk of neuritis.

Adult↗
PubMed2004

Long-term brain magnetic resonance imaging changes after optic neuritis in patients without clinically definite multiple sclerosis.

BACKGROUND: Long-term follow-up of the Optic Neuritis Treatment Trial (ONTT) cohort to evaluate brain magnetic resonance imaging (MRI) in patients who have not developed clinically definite multiple sclerosis. OBJECTIVE: To determine the proportion of patients with monosymptomatic optic neuritis who manifest new brain MRI lesions without having developed clinically definite multiple sclerosis 10 to 14 years after enrollment in the ONTT. DESIGN: Observational study. SETTING: Fourteen clinical centers. PARTICIPANTS: One hundred eight ONTT patients who had not developed clinically definite multiple sclerosis 10 to 14 years after study enrollment. MAIN OUTCOME MEASURE: Development of new T2 lesions on follow-up brain MRI. RESULTS: At least 1 T2 lesion 3 mm or larger was observed on follow-up MRIs in 27 (44%) of 61 patients with normal baseline MRIs. Additional lesions (> or =3 mm) were present on follow-up MRIs in 26 (74%) of 35 patients with abnormal baseline MRIs. CONCLUSIONS: A subset of patients with monosymptomatic optic neuritis manifest neither clinical signs nor MRI evidence of demyelination after more than 10 years of follow-up. In other cases followed up for this length of time, MRI signal abnormalities may accumulate without causing new clinical manifestations of multiple sclerosis. This information is useful in counseling patients who develop first-episode optic neuritis.

Adult↗
PubMed1998

Paraneoplastic cerebellar syndrome and optic neuritis with anti-CV2 antibodies: clinical response to excision of the primary tumor.

OBJECTIVE: To describe a patient with a paraneoplastic cerebellar syndrome and optic neuritis with circulating anti-CV2 antibodies and clinical improvement after excision of a small cell lung carcinoma. DESIGN: Report of a case. SETTING: A 62-year-old man simultaneously developed a severe cerebellar syndrome and a bilateral optic neuritis predominantly in the left eye (visual acuity, 20/25 in the right eye; < 20/400 in the left eye; and bilateral swelling of the optic discs). MAIN OUTCOME AND RESULTS: Anti-CV2 antibodies, recently described as associated with paraneoplastic neurological syndrome, were detected in the patient's serum sample. These antibodies were demonstrated to react with the cytoplasm of a subpopulation of oligodendrocytes in the white matter of rat brain in the cerebellum, brainstem, spinal cord, and optic chiasm. The patient was found to have a small cell lung carcinoma, which was removed. After excision of the tumor, the cerebellar syndrome improved dramatically and the papilledema disappeared despite aftereffects of the optic neuritis. CONCLUSIONS: These findings were consistent with the diagnosis of a paraneoplastic neurological syndrome, although both optic neuritis and remission of the cerebellar syndrome are uncommon patterns of paraneoplastic syndromes. CV2 antigen expression by the oligodendrocytes of the cerebellum, brainstem, spinal cord, and optic chiasm correlated with the clinical syndrome observed in our patient. However, the precise pathophysiological role of anti-CV2 antibodies is still unknown.

Autoantibodies↗
PubMed1978

Quantitative perimetry in compressive optic neuropathy and optic neuritis.

The Goldmann perimetric defects in 20 cases of compressive optic neuropathy and 54 cases of optic neuritis were analyzed. While defects involving the papillomacular bundle were the rule in both compressive and neuritis cases, sparing of the fixational area occurred in 24% of neuritis eyes but in none of the eyes with compressive neuropathy. The most reliable differential perimetric sign was the presence of a hemianopic defect; at least one eye of 15 (75%) cases of compression showed such a defect, which was not found in any neuritis cases. The I2e was the largest kinetic isopter to demonstrate the hemianopic defect in a substantial proportion of cases. These defects were corroborated with sequential static presentation of the I2e to I4e stimuli to either side of the vertical meridan, and with similar techniques using 18/1,000 red test objects at the tangent screen.

Adolescent↗
PubMed1986

Bilateral optic neuritis evolved during tamoxifen treatment.

A 57-year-old woman developed bilateral optic neuritis after being treated for 6 months with tamoxifen in the dosage of 30 to 40 mg orally a day. As the neuritis progressed during continued treatment and no other causal explanation could be found, tamoxifen was stopped and the optic neuritis regressed. Since tamoxifen might cause optic neuritis the authors recommend the monitoring of ocular symptoms in treated patients.

Female↗
PubMed1990

A long-term prospective study of optic neuritis: evaluation of risk factors.

Eighty-six patients with monosymptomatic optic neuritis of unknown cause were followed prospectively for a median period of 12.9 years. At onset, cerebrospinal fluid (CSF) pleocytosis was present in 46 patients (53%) but oligoclonal immunoglobulin in only 40 (47%) of the patients. The human leukocyte antigen (HLA)-DR2 was present in 45 (52%). Clinically definite multiple sclerosis (MS) was established in 33 patients. Actuarial analysis showed that the cumulative probability of developing MS within 15 years was 45%. Three risk factors were identified: low age and abnormal CSF at onset, and early recurrence of optic neuritis. Female gender, onset in the winter season, and the presence of HLA-DR2 antigen increased the risk for MS, but not significantly. Magnetic resonance imaging detected bilateral discrete white matter lesions, similar to those in MS, in 11 of 25 patients, 7 to 18 years after the isolated attack of optic neuritis. Nine were among the 13 with abnormal CSF and only 2 belonged to the group of 12 with normal CSF (p = 0.01). Normal CSF at the onset of optic neuritis conferred better prognosis but did not preclude the development of MS.

Adolescent↗