Visual pathway abnormalities were found in most multiple sclerosis patients despite history of previous optic neuritis / Anormalidades nas vias visuais foram encontradas na maior parte dos pacientes com esclerose multipla independentemente da historia de neurite optica

Objective It was to investigate visual field (VF) abnormalities in a group of multiple sclerosis (MS) patients in the remission phase and the presence of magnetic resonance imaging (MRI) lesions in the optic radiations. Methods VF was assessed in 60 participants (age range 20-51 years): 35 relapsing-remitting MS patients [20 optic neuritis (+), 15 optic neuritis (-)] and 25 controls. MRI (3-Tesla) was obtained in all patients. Results Visual parameters were abnormal in MS patients as compared to controls. The majority of VF defects were diffuse. All patients except one had posterior visual pathways lesions. No significant difference in lesion number, length and distribution was noted between patients with and without history of optic neuritis. One patient presented homonymous hemianopsia. Conclusion Posterior visual pathway abnormalities were found in most MS patients despite history of previous optic neuritis. .

Objetivo Foi analisar o campo visual (CV) de um grupo de pacientes com esclerose múltipla (EM) na fase remissiva e a presença de lesões nas imagens de ressonância magnética (MRI) na radiação óptica. Método O CV foi estudado em 60 participantes (faixa etária de 20-51 anos): 35 pacientes EM remitente-recorrente: [20 neurite óptica (+), 15 neurite óptica (-)] e 25 controles. Foram obtidas MRI (3-Tesla) de todos os pacientes. Resultados Havia alterações visuais nos pacientes com EM quando comparados aos controles. A maioria apresentava defeitos difusos de CV. Todos os pacientes, à exceção de um, apresentaram lesões nas vias visuais posteriores. Não foi observada diferença significativa quanto a número, extensão e distribuição das lesões entre os pacientes com e sem história de neurite óptica. Um paciente apresentou hemianopsia homônima. Conclusão Anormalidades nas via visuais posteriores foram encontradas na maior parte dos pacientes com EM independentemente da história de neurite óptica. .

Orbital Doppler Evaluation of Blood Flow Velocities in Optic Neuritis

PURPOSE: To evaluate orbital blood flow velocities and optic nerve diameter with Doppler and gray-scale sonography in patients with acute unilateral optic neuritis (ON). METHODS: Orbital Doppler and gray-scale sonography was performed in 46 eyes of 23 patients aged 19- to 47-years with acute unilateral ON. ON was diagnosed by an ophthalmologist on the basis of clinical presentation, presence of decreased visual acuity and assessment of visual evoked potentials. The peak systolic velocity (PSV) and end-diastolic velocity (EDV), as well as the resistance index (RI) and pulsatile index (PI) of the ophthalmic artery (OA), central retinal artery (CRA), posterior ciliary arteries (PCAs) and optic nerve diameter were measured in both eyes. We compared results from affected and unaffected eyes using the paired t-test. The area under the receiver operating characteristic (ROC) curves was used to assess the diagnosis of ON based on measured blood flow parameters of the OA, CRA and PCAs and optic nerve diameter. RESULTS: The mean (standard deviation) optic nerve diameter in eyes with ON was 4.1 (0.8) mm, which was significantly larger than the 3.0 (0.4) mm diameter measured in unaffected control eyes (p 0.05). The mean RI in the PCAs was slightly lower in the eyes with ON than in the contralateral eyes (0.60 vs. 0.64, p < 0.05). The area under the ROC curves indicated that optic nerve diameter was the best parameter for the diagnosis of ON. CONCLUSIONS: Optic nerve diameter was related to ON, but orbital blood flow parameters were not.

Neuritis óptica en niños: experiencia clínica en 13 años / Optic neuritis in children: clinic experience in 13 years

Background: In pediatric optic neuritis usually occurs after an infectious event, with papilledema, bilateral and with good prognosis, with a low incidence of conversion to multiple sclerosis. The aim of this paper is to present the clinical and laboratory characteristics of cases of optic neuritis in children. Patients and Methods: 10 clinical cases of optic neuritis in children and youth aged 5 to 17 years, referred between 1995 to 2007. Results: The median age at presentation was 11 years. 8 cases were females. Four cases with a history of respiratory infection, bilateral involvement in 8 of 10 patients and 5 cases of retrobulbar optic neuritis. Magnetic resonance imaging showed T2 hyperintensity in the optic nerves affected in 5 patients. The study of cerebrospinal fluid was normal and oligoclonal bands in all cases. The cases treated with intravenous methylprednisolone had good recovery. Two cases have multiple sclerosis. Discussion: In this series of female patients predominated and limited history of previous infection. Cases with multiple sclerosis showed no clinical differences, but more hyperintense lesions on magnetic resonance. The cases treated with methylprednisolone had good visual prognosis.

Antecedentes: En pediatría la neuritis óptica generalmente se presenta después de un cuadro infeccioso, con edema de papila, que suele ser bilateral y tiene buen pronóstico. La conversión a esclerosis múltiple es baja. Nuestro objetivo es presentar las características clínicas y de laboratorio de casos de neuritis óptica en pediatría. Pacientes y Método: Se analizan 10 casos clínicos de neuritis óptica en niños y jóvenes entre 5 y 17 años, referidos entre los años 1995 a 2008. Resultados: La edad media de la serie fue de 11 años. 8 casos eran de sexo femenino; cuatro tenían antecedentes de infección respiratoria. En 8 de 10 pacientes el compromiso fue bilateral y 5 casos evolucionaron con neuritis óptica retrobulbar. La resonancia magnética mostró hiperintensidad en T2 en los nervios ópticos afectados en 5 pacientes. El estudio de líquido cefalorraquídeo y bandas oligoclonales fue normal en todos los casos. Los pacientes tratados con metilprednisolona endovenosa tuvieron buena recuperación. Sólo dos casos evolucionaron a esclerosis múltiple. Discusión: En esta serie predonimaron los pacientes de sexo femenino y el antecedente infeccioso fue poco frecuente. Los casos que evolucionaron a esclerosis múltiple no mostraron diferencias clínicas; sólo presentaron mayor cantidad de lesiones hiperintensas en la RM. Tuvieron mejor pronóstico visual los enfermos tratados con metilprednisolona.

A comparative study of visual evoked potentials in optic neuritis and optic neuritis with multiple sclerosis.

OBJECTIVE: To compare the visual evoked potentials (VEP) in patients with acute optic neuritis, recurrent optic neuritis, and optic neuritis with multiple sclerosis. MATERIAL AND METHOD: The authors retrospectively reviewed VEP latency records of the patients with optic neuritis in Siriraj Hospital from 1995 to 2005 and divided them into three groups, acute optic neuritis, recurrent optic neuritis, and optic neuritis with multiple sclerosis (ON/MS). The patients with non-recordable VEP in the analysis were excluded. Comparison of the mean latency of the VEP in affected eyes among the three groups was statistically analyzed by a nonparametric independent sample test. RESULTS: Twenty-two patients with acute optic neuritis, 8 patients with recurrent optic neuritis, and 22 patients with ON/MS participated in this study. The mean age among the three groups was not statistically significant. The median value of the latency of flash VEP (fVEP) and pattern reversal VEP (PRVEP) in the acute optic neuritis group was shorter than that of the recurrent optic neuritis group, and statistically significant (fVEP p = 0.012; PRVEP, p = 0.004). The median value of the latency of PRVEP in the acute optic neuritis group was shorter than that of the ON/MS group, and statistically significant (PRVEP p = 0.002). The median value of the latency of both fVEP and PRVEP in the recurrent optic neuritis group and ON/MS group were delayed with no statistical significance (fVEP p = 0.458; PRVEP, p = 0.403). CONCLUSION: The VEP can be used to demonstrate the demyelinating mechanism of optic neuritis and optic neuritis with multiple sclerosis, but cannot determine the susceptibility of the patients with acute ON to become MS. The significantly delayed latency of VEP in recurrent optic neuritis is possibly caused by severe damage of the optic nerve conduction from recurrent attacks.

The clinical profile of childhood optic neuritis

PURPOSE: To report the clinical features and outcome of a series of children with optic neuritis. METHODS: We reviewed the medical records of patients up to 16 years old with optic neuritis. Group 1 comprised children seen up to two weeks after the onset of visual loss; Group 2 comprised patients already harboring optic atrophy. RESULTS: There were 15 boys and 12 girls. The mean age was 10.9 years. Bilateral optic neuritis occurred in 10. Optic disc pallor was found in 35 percent, edema in 46 percent, and 19 percent had normal fundus. During follow-up visual acuity improved in all but one eye in Group 1, and in six of seven eyes in children in Group 2. Just one child converted to multiple sclerosis. CONCLUSIONS: This study shows that the clinical features of childhood optic neuritis differ from those observed in adults. In children it has a better visual outcome and a lower conversion rate to multiple sclerosis than in adults

Neuritis óptica isquémica por enfermedad de Horton (arteritis de la temporal)

Entre las patologías vasculares isquémicas destacan las producifas por enfermedades inmunitarias; entre éstas se incluye la arteritis de células gigantes y la enfermedad de Horton o vasculitis de la arteria temporal, las mismas que se caracterizan por su gravedad y alto polimorfismo clínico debido al daño vascular por compromiso de la arteria carótida produciendo lesiones irreversibles a nivel del nervio óptico (ceguera). Se debe sospechar esta patología en todo paciente anciano que curse con amaurosis fugaz, compromiso de la arteria carótida sumado a la périda auditiva neurosensorial.

Caracterizaçäo etiológica e clínica das neurites ópticas infecciosas / Etiological and clinical characteristics of infectious optic neuritis

As neurites ópticas infecciosas (NOI) foram estudadas em relaçao aos aspectos etiológicos, epidemiológicos e clínicos, com o intuito de detectar características que possam diferencia-las das neurites ópticas desmielinizantes (NOD), que apresentam nítida tendência para conversao em esclerose múltipla. Entre 105 casos de NOI, 51 nao apresentavam qualquer evidência de envolvimento da coróide ou retina e poderiam ser confundidos com NOD. Envolvimento bilateral foi encontrado em 23 pacientes (45,1 por cento), sendo simultâneo em 18 (78,3 por cento) casos. A relaçao entre sexos foi 2M:1F. As idades variaram entre 1 a 82 anos, com mediana de 34,8 anos. Um terço dos pacientes tinha idades até 20 anos, e em um terço dos pacientes as idades eram igual ou maior que 50 anos. Sífilis foi encontrada em 19 pacientes sendo a causa mais comum das NOI, enquanto infecçoes virais diversas foram responsabilizadas em 41.2 por cento. A acuidade visual foi gravemente afetada na maioria dos casos, sendo pior que 20/200 em 57,3 por cento dos olhos acometidos. Distúrbios da visao cromática foram encontrados em 91,8 por cento, enquanto o exame do campo visual revelou anormalidades em 92,6 por cento dos olhos, predominando os defeitos centrais (40,7 por cento). O disco óptico estava anormal em 90.5 por cento dos olhos examinados, sendo atrofia óptica o principal achado fundoscópico. O presente estudo demonstra que a maior tendência a bilateralidade e simultaneidade das NOI, sua maior prevalência no sexo masculino, na infância e em adultos após os 50 anos de idade, assim como a maior severidade do comprometimento das funçoes visuais diferem substancialmente das características relatadas nas NOD. O conhecimento destas diferenças pode auxiliar na diferente abordagem terapêutica e prognóstica das duas distintas condiçoes.

Fibrose sub-retiniana progressiva e neurite óptica; descriçäo de um caso / Progressive subretinal fibrosis and optic neuritis; description of case

Descrevemos um caso raro de fibrose sub-retiniana progressiva subsequente à coroidite multifocal, associado a uma severa e dramática neurite óptica resistente à prednisona, à droga citotóxica e finalmente à ciclosporina. A literatura foi revista e discutida

Neuritis óptica: protocolo latinoamericano / Optic neuritis: latinamerican protocol

Para definir las características de la neuritis óptica (NO) en países del hemisferio sur, se efectuó un estudio prospectivo en 4 ciudades entre los paralelos 32 y 37 de latitud sur en Argentina y Chile. Se estudiaron 85 pacientes de los que se consignó edad, sexo, compromiso monocular o binocular y presencia de dolor ocular. Se examinó la agudeza visual, reflejos pupilares, motilidad ocular, fondo de ojo y campo visual con perímetro de cúpula. Se esperó una recuperación de la visión de colores y potencial visual evocado. Todos los pacientes fueron examinados por un solo neurólogo en cada centro de referencia. El promedio de edad de nuestros pacientes fue de 33 años (con un rango de 2,5 a 59 años). 71 por ciento eran mujeres y 29 por ciento hombres. En el 74 por ciento de los casos NO fue unilateral y en el 26 por ciento bilateral. Los pacientes relataron en forma espontánea una historia de dolor y retrobulbar en el 41 por ciento. 74 por ciento de nuestros casos presentaron, como alteración del campo visual, un escotoma central. Las características clínicas de los pacientes de este estudio son semejantes a las publicadas en la literatura del hemisferio norte; excepto en la mayor frecuencia de neuritis bulbar en nuestros casos

Uso de los glucocorticoides en el tratamiento de la neuritis óptica / Use of glucocorticoids in optic neuritis treatment

Se presenta una síntesis del estudio multicéntrico de tratamiento de la neuritis óptica efectuado en varios centros de los Estados Unidos de Norteamérica. Se presentan las características clínicas de la neuritis óptica de este grupo de pacientes. Además se informa de los hallazgos neurológicos en el examen inicial, la incidencia de esclerosis múltiple, los hallazgos de la resonancia magnética cerebral y finalmente el valor terapéutico de los corticoides

Neuro-oftalmo-criptococosis en dos pacientes con SIDA / Neuro-ophthalmo-cryptococcosis in 2 patients with AIDS

La criptococosis es una causa importante de morbimortalidad en pacientes con Sida. Es la infección oportunística que ocurre en segundo lugar de frecuencia a nivel oftalmológico, después de la retinitis a citomegalovirus. Un 40 por ciento de los pacientes afectados de criptococosis meníngea presentan compromiso ocular. Se describen dos casos clínicos de compromiso neurooftalmológico con evolución fatal. Se analizan las manifestaciones clínicas, así como los exámenes diagnósticos pertinentes y aspectos terapéuticos

VER in optic neuritis.

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.