Neurological outcome and predictive factors of idiopathic optic neuritis in China.

BACKGROUND: The neurological outcome and predictive factors of idiopathic optic neuritis (ION) in China are largely unknown. OBJECTIVE: The aim of this paper is to study the neurological outcome of Chinese ION and to investigate the early predictors for multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD). METHOD: Retrospective medical record review and supplementary follow-up of 107 ION patients was performed. Statistical analysis of the baseline characteristics as risk factors for ION patients converting into MS or NMOSD was performed. RESULTS: With an average disease course of 9.5years, 19 of the 107 (17.7%) ION patients developed either MS (9, 8.4%) or NMOSD (10, 9.3%). The estimated 5-year and 10-year combined accumulative risk rates were 14.1% and 26.0%, respectively. Significantly higher estimated accumulative conversion risk was found in female versus male (P=0.047), adult versus children (P=0.032), patients with brain MRI lesions versus patients without leasions (P=0.026), patients with CSF positive oligoclonal bands and/or elevated IgG index versus without (P=0.003) and patients with poor visual recovery versus patients with good recovery (P=0.007). Furthermore, brain white matter lesions and good visual recovery were statistically more common typically in MS converters compared with the NMOSD converters (P=0.01 and P=0.006, respectively). CONCLUSION: The combined conversion rate for ION to MS/NMO in Chinese population was lower than the reported rate for Western countries. In addition to some previously reported high risk factors, white matter lesions on the brain MRI at baseline and good visual recovery were found to be good predictors for Chinese ION converting into MS whereas poor visual recovery with a normal brain MRI suggested a higher likelihood of the ION converting into NMOSD.

Vogt-Koyanagi-Harada disease and fungal meningitis.

PURPOSE: To describe a patient who initially presented with features of Vogt-Koyanagi-Harada disease and who eventually demonstrated symptoms of mycotic meningitis. METHODS: An 18-year-old immunocompetent boy showed a disseminated uveitis with patchy thickening of the posterior choroid. A clinical neurologic examination and a microbiological assessment revealed neck stiffness as well as pleocytosis, increased protein content, a decreased concentration of glucose and chloride, and cryptococcal fungi in the cerebrospinal fluid. It led to the diagnosis of cryptococcal meningitis. RESULTS: Antifungal therapy was initiated and given for 2 months. After bilateral retrobulbar injections of 2.5 mg of dexamethasone and 20 mg of triamcinolone acetonide, choroidal edema regressed and visual acuity increased from 0.4 to 1.0 at 3 weeks after start of therapy. Microbiological examination of cerebrospinal fluid samples taken 30 days later was unremarkable. Ophthalmoscopy showed some fine pigment clumping and depigmentation in the macula. CONCLUSION: According to the International Nomenclature Committee for Vogt-Koyanagi-Harada diagnosis, the patient was diagnosed with incomplete Vogt-Koyanagi-Harada because he had not suffered any ocular trauma, had not undergone ocular surgery, and presented with bilateral multifocal choroiditis accompanied by signs of meningitis without skin abnormalities. Because skin changes can occur months to years after the initial symptoms, the patient may eventually fulfill the criteria for complete Vogt-Koyanagi-Harada disease.

[Clinical study of optic neuritis combined with viral hepatitis].

OBJECTIVE: To investigate the clinical manifestation, management and prognosis of optic neuritis combined with viral hepatitis. METHODS: Retrospective study case series. Clinical data from twenty patients with optic neuritis combined with hepatitis who were hospitalized in Beijing Tongren Hospital neural eye ward from September 2003 to June 2010 were collected, the clinical characteristics and visual field changes in the group of patients were summarized, and comparison between the vision before and after treatment was made by the Wingerchuk vision classification. RESULTS: Among the twenty patients, eighteen patients had chronic hepatitis B and two patients had chronic hepatitis C. Thirteen (65%) patient were monocular, sixteen (80%) patients were single-phase course. Twenty-seven eyes were affected. Disc edema was very common which was found in 14 eyes (52%), severe vision impairment (Best corrected visual acuity worse than 20/200) were recorded in 19 eyes (70%). Lower altitudinal visual field impairment was more common which was found in 10 eyes (50%). All patients were followed for 3 months after steroid therapy, complete visual recovery or significant improvement was seen in only 3 eyes (11%) or 4 eyes (15%). Minor improvement was seen in 12 eyes (44%), while 8 eyes (30%) had no improvement. CONCLUSIONS: In this study, optic neuritis combined with hepatitis usually showed severe visual impairment. Although the vision of some patients could completely recover after steroid therapy, most of the patients had poor recovery. Combination of steroid and anti-viral therapy should be considered in the management of optic neuritis combined with hepatitis.

[Anti-MOG antibody in different types of immune-mediated optic neuritis].

OBJECTIVE: To investigate the expression of anti-myelin oligodendrocyte glycoprotein antibody (MOG-Ab) in different types of immune-mediated optic neuritis (IM-ON). METHODS: Case-control and cross section study. The serum of 129 consecutive cases of immune-mediated optic neuritis (IM-ON group) seen in Neuro-ophthalmology clinic in Department of Neurology, Beijing Tongren Hospital during May 2010 and February 2011 were collected. All IM-ON cases were further classified into five different types as: 20 cases of multiple sclerosis related ON (MS-ON), 13 cases of neuromyelitis optical related ON (NMO-ON), 33 cases of autoimmune optic neuritis (AON), 43 cases of relapsing isolated optic neuritis (RION) and 20 cases of solitary isolated optic neuritis (SION). MOG-Ab was tested by ELISA. The positivity rate and titer of MOG-Ab among these groups were compared using chi-square test and ANOVA, t test by SPSS17.0 software. RESULTS: MOG-Ab was positive in 12 of all 129 tested IM-ON patients (9.3%), in which there were 5 of 20 MS-ON, none of 13 NMO-ON, 4 of 33 AON, 2 of 43 RION, and 1 of 20 SION patients. There were no statistical significant difference among five groups (Fisher's exact test, χ(2) = 7.051, P = 0.088), but MS-ON group showed statistically higher MOG-Ab positivity and titer than the "NMO spectrum optic neuritis" group which was merged from the other 4 IM-ON groups. CONCLUSION: MOG-Ab could be detected in different types of immune-mediated optic neuritis except NMO-ON and the expression of MOG-Ab was statistically higher in MS-ON group than the 'NMO spectrum optic neuritis' group.