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Cranial Neuropathies II, III, IV, and VI
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Tanyatuth Padungkiatsagul, Heather E. Moss
The diagnosis of optic neuritis is made based on clinical presentation. Magnetic resonance imaging (MRI) shows segmental gadolinium enhancement of the optic nerve in over 90% of cases. Magnetic resonance imaging (MRI) of the brain is important to evaluate for risk of current or future MS. ONTT 15-year follow-up data showed that patients who had one or more white matter lesions on their initial MRI had a 72% risk of developing MS at 15 years, while those with no lesions on the baseline MRI had a risk of 25%.7 Per the most recent MS diagnostic criteria, MS can be diagnosed in a patient with optic neuritis who has both enhancing and non-enhancing brain MRI lesions or has both non-enhancing brain lesions and CSF oligoclonal bands (OCBs).8
Apparent Sudden Visual Loss: An Essential Approach
Published in Amy-lee Shirodkar, Gwyn Samuel Williams, Bushra Thajudeen, Practical Emergency Ophthalmology Handbook, 2019
Optic neuritis: The decision whether to treat with corticosteroids remains controversial. Intravenous corticosteroids may speed visual recovery but does not appear to affect the final VA recovery. Whilst oral steroids are unhelpful (follow local protocols and refer to neurology).
Emergency management of the complications of infective sinusitis
Published in S. Musheer Hussain, Paul White, Kim W Ah-See, Patrick Spielmann, Mary-Louise Montague, ENT Head & Neck Emergencies, 2018
Optic neuritis secondary to acute sinusitis is a rare event, but even so, knowledge of the potential association is helpful. Most cases of optic neuritis are in fact due to multiple sclerosis. Those cases associated with sinus disease may be due to an adjacent mucocele or mucopyocele or purulent acute sinusitis. The latter association may be predisposed by dehiscent bony barriers (Figure 6.10). The clinical signs suggesting optic neuritis include orbital pain, especially on eye movement, and blurring or loss of vision, especially centrally. The management should be multidisciplinary and should include ophthalmological advice, appropriate CT/MRI scans, microbiology and consideration for early decompression by sinus surgery.
Atypical Case of MOG Antibody-Associated Optic Neuritis with Roth Spots
Published in Ocular Immunology and Inflammation, 2023
Jennifer Aboab, Marie-Hélène Errera, Sophie Espinoza, Jean-François Girmens, Emmanuel Héron
A 49-year-old woman presented to the Emergency Room with 1 week history painful visual loss in the left eye. Her visual acuity was reduced to Couting Fingers at 2 meters in the affected eye and had 12/10 (decimal) (=20/15) in the right eye. Both intra-ocular pressure and macroscopic examination were normal. Funduscopy exam showed a severe optic disc edema associated with multiple peripapillar hemorrhages and peripheral retinal hemorrhages in the left eye (Figure 1). The veins seemed more tortuous and dilated than in the fellow eye. Roth spots were also seen in this left eye (Figure 2). The right-eye fundoscopy was normal. Goldmann visual fields showed an altitudinal inferior defect in the left eye. OCT-RNFL showed an increased volume of retinal nerve fiber layer in the affected eye. The diagnosis of optic neuritis in the left eye was suspected because of the painful visual loss. However, because of this atypical presentation and the differential diagnosis of anterior ischemic optic neuropathy, a fluorescein retinal angiography was performed and ruled out a retinal vasculitis (Figure 3). Brain and orbit MRI was performed and revealed an hyperintensity in the left optic nerve, enhanced with gadolinium in the anterior and the cisternal portion of the nerve (Figure 4a). A posterior scleral enhancement in the left eye was also noted by the radiologist on MRI (Figure 4b), but ultrasound was not performed.
An Atypical Case of Enterovirus Meningitis Presenting with Unilateral Optic Disc Swelling and Minimal Optical Symptoms
Published in Ocular Immunology and Inflammation, 2023
Efthymios Karmiris, Georgios Vasilakos, Konstantinos Tsiripidis, Evangelia Chalkiadaki
Οur patient had no clinical symptoms and signs except from a reduction in visual quality, therefore, we had to exclude a broad range of diseases causing optic disc swelling, both typical and atypical. There are various possible causes of spontaneous optic neuritis. First, optic neuritis is often a symptom of demyelinating diseases such as multiple sclerosis or neuromyelitis optica spectrum disorders.4 In our case no spinal cord and brain abnormalities were found on brain and spine MRI. In addition, tests for anti-MOG and AQP-4-IgG antibodies showed negative results. Second, the possibility of other autoimmune or systemic diseases were considered. This required comprehensive patient evaluation, including hematologic, spinal and neuroimaging studies, which were all unremarkable in our case. Third we considered optic neuritis due to infectious disease or inflammatory reaction. Optic disc swelling on fundoscopy can be caused by almost all infections.3 When considering the CSF findings of our patient, it was most likely that the diagnosis was enterovirus optic papillitis accompanying aseptic meningitis, even if, surprisingly, the patient had no neurological symptoms.
Neuro-Ophthalmic Literature Review
Published in Neuro-Ophthalmology, 2022
David A. Bellows, John J. Chen, Jenny A. Nij Bijvank, Michael S. Vaphiades, Xiaojun Zhang
Patients were identified who illustrated an atypical natural history of incipient optic neuritis, which included idiopathic optic neuritis, seropositive neuromyelitis optica spectrum disease, anti-myelin oligodendrocyte glycoprotein antibody disease, and multiple sclerosis in one patient each. Features of interest included an atypical temporal relationship between development of pain and onset of clinical optic neuropathy, an unusually protracted duration of pain, and an unusually long duration of worsening optic neuropathy before stabilisation. The authors concluded that most patients with optic neuritis present with painful vision loss, which progresses over 1 week or less. Careful attention to the exceptions described herein may facilitate earlier recognition of diagnostically challenging cases.