VISUAL LOSS IN MULTIPLE SCLEROSIS AND ITS RELATION TO PREVIOUS OPTIC NEURITIS, DISEASE DURATION AND CLINICAL CLASSIFICATION

CRION is a rare cause of optic neuritis. It is usually bilateral, painful and associated with profound visual loss. Significant response to corticosteroid treatment is typical but relapse is common when treatment is withdrawn. We present 2 cases of possible CRION and discuss the diagnostic and management considerations.Case 1: 50-year-old woman presented with right optic neuritis which spontaneous recovered. A year later she had left painful visual loss which improved with a short course of corticosteroids. MRI neuroaxis revealed left optic nerve enhancement. Non-specific, faint unmatched OCBs were detected. AQP4-IgG was negative. Nine months later she had further visual loss in her left eye. Prednisolone and azathioprine were commenced.Case 2: 55-year-old woman with bilateral, painless visual acuity deterioration over two weeks. Investigations revealed negative anti-aquaporin 4 antibodies (AQP4-IgG), normal MRI of the neuroaxis, negative oligoclonal bands (OCBs) and visual evoked potentials showed bilateral delay. Serum ACE was slightly elevated. She was started on a tapering course of steroids and had significant visual acuity improvement.The diagnosis of CRION involves the exclusion of other causes of optic neuritis, particularly multiple sclerosis (MS), Neuromyelitis Optica (NMO) and sarcoidosis. Correct diagnosis is important as aggressive and long-term immunosuppression is required.

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A Case of Relapsing Visual Loss

Neuroimmunology ◽

10.1093/med/9780190693190.003.0028 ◽

2018 ◽

pp. 149-152

Author(s):

Aaron E. Miller ◽

Tracy M. DeAngelis ◽

Michelle Fabian ◽

Ilana Katz Sand

Keyword(s):

Multiple Sclerosis ◽

Optic Neuritis ◽

Visual Loss ◽

Diagnostic Testing ◽

High Dose ◽

Inflammatory Condition ◽

Steroid Dependence ◽

Eye Pain ◽

Clinical Stability

Chronic relapsing optic neuritis (CRION) is a rare inflammatory condition that is characterized by repeated episodes of optic neuritis. Diagnostic testing for all other causes of optic neuropathy is negative in CRION, and the diagnosis is made on clinical grounds. At some point in the condition, both optic nerves are commonly affected. Eye pain often precedes the visual symptoms. Visual loss can be more severe than in optic neuritis from multiple sclerosis. Steroid dependence is usual, with a rebound in symptoms upon steroid discontinuation. Treatment involves high-dose steroids followed by a long taper. Most patients require long-term immunosuppression to maintain clinical stability.

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Apo E in multiple sclerosis and optic neuritis: the Apo E-o4 allele is associated with progression of multiple sclerosis

Multiple Sclerosis Journal ◽

10.1191/1352458505ms1207oa ◽

2005 ◽

Vol 11 (5) ◽

pp. 511-515 ◽

Cited By ~ 21

Author(s):

M Pinholt ◽

J L Frederiksen ◽

P S Andersen ◽

M Christiansen

Keyword(s):

Multiple Sclerosis ◽

Optic Neuritis ◽

Disease Progression ◽

Disease Duration ◽

Genotype Distribution ◽

Negative Group ◽

Homogeneous Population ◽

Positive Group ◽

Apo E ◽

Apo E Genotype

Objective: To investigate the association between apolipoprotein E (Apo E) genotype in multiple sclerosis (MS) and acute monosymptomatic optic neuritis (ON) in a genetically homogeneous population with a high frequency of the Apo o4 allele. Background: The association between heterozygosity of Apo o4 and the development of MS is thoroughly investigated, while the association between homozygosity of Apo o4 and the development of MS is insufficiently studied. The association between Apo E genotype and disease progression remains controversial. Methods: 475 patients were included, 385 with MS and 90 with ON, consecutively seen in the MS clinic in the County of Copenhagen. Clinical data were obtained from medical records and degree of disability was determined prospectively using the Kurtzke expanded disability status scale (EDSS). Blood samples were used for Apo E genotyping. Disease progression was evaluated by the progression index (PI=EDSS/disease duration). Apo E genotype distribution was compared with 361 healthy controls. Results: The Apo o genotype distribution in the MS and ON groups was similar to the controls. The rate of disease progression in the group of MS patients with a disease duration of 10 years or less was significantly faster in the Apo o4 positive group (heterozygosity and homozygosity for Apo o4) (PI=1.41) compared to the Apo o4 negative group (PI=0.92) (P=0.009). Observing the MS subgroups, we found that the group of patients with RRMS had a faster rate of disease progression in the Apo o4 positive group (PI=1.12) compared to the Apo o4 negative group (PI=0.77) (P=0.024). Conclusions: Apo E genotypes do not influence the development of MS and ON. The Apo o4 allele seems to predispose carriers with MS to a faster progression of disease.

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The clinical profile of childhood optic neuritis

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2001000300001 ◽

2001 ◽

Vol 59 (2B) ◽

pp. 311-317 ◽

Cited By ~ 22

Author(s):

Marco Aurélio Lana-Peixoto ◽

Gustavo Cardoso de Andrade

Keyword(s):

Multiple Sclerosis ◽

Optic Neuritis ◽

Clinical Features ◽

Medical Records ◽

Visual Loss ◽

Visual Outcome ◽

The Mean ◽

Group 2 ◽

Group 1

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%, edema in 46%, and 19% 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.

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104 Severe unilateral optic neuritis in multiple sclerosis

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2018-anzan.103 ◽

2018 ◽

Vol 89 (6) ◽

pp. A41.2-A41

Author(s):

Natasha Gerbis ◽

John Parratt

Keyword(s):

Multiple Sclerosis ◽

Visual Acuity ◽

Optic Neuritis ◽

Visual Loss ◽

Case Series ◽

Retinal Nerve Fibre Layer ◽

High Dose ◽

List Type ◽

The Mean

IntroductionOptic neuritis (ON) results in acute loss of vision with pain on eye movement. It may be the first manifestation of multiple sclerosis (MS) and usually follows a resolving course. Here we describe five patients with MS who developed severe unilateral ON resulting in persistent visual loss without significant resolution.MethodsA retrospective clinical review of five cases identified from a database of 550 patients with MS.ResultsAll patients were female and the mean age was 30 years at onset (range 25–40). All patients had no light perception at diagnosis, and received treatment with high dose intravenous methylprednisolone. Two patients also had plasma exchange. All of the patients were subsequently treated with immunomodulatory therapy. The patients were followed for a mean period of 13.3 years (range 2 months to 31 years). None of the patients had significant improvement in their visual acuity, with most achieving vision of 6/60. The mean retinal nerve fibre layer thickness was 66.33 microns (range 46–98 microns) in the affected eye, compared to 86.7 microns (69–105 microns) in the unaffected eye. All patients were aquaporin-4 antibody negative and oligoclonal band positive, with the MRI brain and spine being diagnostic for MS. Interestingly, none of the patients developed significant symptoms in the contralateral eye with vision of 6/5. All patients had an EDSS score of 4.0 predominantly due to visual impairment.ConclusionSevere unilateral ON is rarely seen in MS. This case series highlights a phenotypically distinct group of female MS patients with severe unilateral ON, and no improvement in visual acuity after prolonged follow-up and despite treatment with steroids and potent immune therapies. In such patients, where the diagnosis of MS is confirmed by MRI and CSF analysis, the patient might be reassured that visual loss in the fellow eye is unlikely.References. Wilhelm H, Schabet M. The diagnosis and treatment of optic neuritis. Deutsches Arzteblatt International2015;112(37):616–626.. Dachsel RM, et al. Optic neuropathy after retrobulbar neuritis in multiple sclerosis: Are optical coherence tomography and magnetic resonance imaging useful and necessary follow-up parameters?Der Nervenarzt2015;86(2):187–96.

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Brief Overview and Experience of Visual Evoked Potential of First 67 cases at Referral Neuroscience Hospital in Bangladesh

Journal of National Institute of Neurosciences Bangladesh ◽

10.3329/jninb.v6i2.50744 ◽

2020 ◽

Vol 6 (2) ◽

pp. 74-77

Author(s):

Mohammad Enayet Hussain ◽

Bithi Debnath ◽

AFM Al Masum Khan ◽

Md Ferdous Mian ◽

Md Nahidul Islam ◽

...

Keyword(s):

Multiple Sclerosis ◽

Optic Neuritis ◽

Clinical Diagnosis ◽

Optic Neuropathy ◽

Cross Sectional Study ◽

P Value ◽

Pattern Reversal ◽

Cross Sectional ◽

The Mean ◽

Visual Evoked

Background: The visual evoked potentials (VEP) is a valuable tool to document occult lesions of the central visual channels especially within the optic nerve. Objectives: The purpose of the present study was to observe the findings of first few cases of VEP done in the neurophysiology department of the National Institute of Neurosciences (NINS), Dhaka, Bangladesh. Methodology: This cross-sectional study was conducted in the Department of Neurophysiology at the National Institute of Neurosciences and Hospital, Dhaka, Bangladesh from September 2017 to March 2020. All patients referred to the Neurophysiology Department of NINS for VEP were included. Pattern reversal VEPs were done using standard protocol set by International Federation of Clinical Neurophysiology (IFCN). Results: The mean age of the study population was 30.70 (±12.11) years (6-68 years) with 31 (46.3%) male and 36 (53.7%) female patients. The mean duration of illness was 8.71 (±1.78) months (3 days- 120 months). Most common presenting symptom was blurring of vision (37.3%) and dimness of vision (32.8%). Patterned VEP revealed mixed type (both demyelinating and axonal) of abnormality in most cases [29(43.35)]. The most common clinical diagnosis was multiple sclerosis (29.85%) and optic neuropathy (26.87%). In the clinically suspected cases of multiple sclerosis, optic neuropathy and optic neuritis most of the cases of VEP were abnormal and the p value is 0.04 in optic neuropathy and optic neuritis. Conclusion: The commonest presentation of the patients in this series were blurring of vision and dimness of vision. The most common clinical diagnosis for which VEP was asked for, was optic neuritis and multiple sclerosis. Most abnormalities were of mixed pattern (demyelinating and axonal). Journal of National Institute of Neurosciences Bangladesh, 2020;6(2): 74-77

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