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A 45 year-old man with prior optic neuritis in the right eye. The right optic disc (A) is pale compared to the normal left optic disc (B).
Source publication
Demyelinating optic neuritis is the most common cause of unilateral painful visual loss in the United States. Although patients presenting with demyelinating optic neuritis have favorable long-term visual prognosis, optic neuritis is the initial clinical manifestation of multiple sclerosis in 20% of patients. The Optic Neuritis Treatment Trial (ONT...
Citations
... Optic neuritis is expected to respond to steroid treatment, with faster recovery in patients undergoing IV steroids; however, no such studies in the pediatric population are available [32]. ...
... ON may be the initial presentation in ~ 20% of patients affected by MS, and up to 50% of patients with MS may experience during their life [2]. ...
... Different disorders determine the inflammation of the optic nerve, but the form caused by MS related demyelination is the most common [2]. Demyelinating ON represents the first manifestation of MS in about 20% of patients [19] and a diagnosis that brings great concerns to patients who are often young and previously healthy. ...
Aim
Our aim was to assess MRI findings in the acute phase of ON and their correlation with visual acuity at presentation, visual outcome (VO) and MS development, to analyze a possible correlation between lesions number and diagnosis, and to assess correlation between orbits MRI and OCT.
Materials and methods
We retrospectively studied 37 patients, who presented to our Emergency Department with an ON first episode from January 2015 to January 2017. Patients underwent immediately a complete neuro-ophthalmological evaluation, blood test, CSF analysis. MRI of brain, orbits, cervical spine was executed within 7 days from ON onset. Brain MRI was classified as: normal, non-specific, suspected demyelination, lesions with dissemination in space and time. Optic nerves findings were localized in three sites (intra-orbital, canalicular and chiasmal) and classified as: normal, STIR- alteration, altered contrast enhancement. Patients underwent neuro-ophthalmological follow-up and MRI at 6 months to assess VO (complete recovery, partial recovery, deficit persistence). Another follow-up at 1 year was performed to identify MS or clinically isolated syndrome (CIS).
Results
64.8% patients received a diagnosis of MS; 35% of CIS. Lesions of the optic nerve were found in 65.8%. We observed statistically significant correlation between brain MRI pattern and diagnosis and between lesions number and diagnosis. We observed a statistically significant correlation between orbital MRI pattern and optical coherence tomography (OCT) results. MRI brain findings correlate with development of MS. MRI brain features and lesions number can predict the risk of MS conversion.
... To date, the most valuable predictor for the development of subsequent clinically definite MS (CDMS) is the presence of white matter (WM) abnormalities on brain MRIs corresponding to demyelinating lesions (Balcer, 2006;Shams and Plant, 2009;Dooley and Foroozan, 2010;Menon et al., 2011). However, most ON patients, particularly clinically isolated ON patients, do not present evidence of brain lesions in conventional brain MRI scans. ...
Purpose: To investigate spontaneous brain activity amplitude alterations in single and relapsing optic neuritis (sON and rON, respectively) and their relationships with clinical variables.
Methods: In total, 42 patients with sON, 35 patients with rON and 50 healthy volunteers were recruited. Resting-state functional Magnetic Resonance Imaging (rs-fMRI) scans were acquired for all participants and compared to investigate the changes in the amplitude of low-frequency fluctuations (ALFFs) among the three groups. The relationships between the ALFFs in regions with significant differences in the groups and clinical variables, including the logarithm of minimal angle of resolution (LogMAR), Expanded Disability Status Scale (EDSS) score and disease duration, were further explored.
Results: Compared with healthy volunteers, the sON and rON patients showed significantly decreased ALFFs in several regions of the occipital and temporal lobes (i.e., inferior occipital gyrus and superior temporal gyrus; corrected p < 0.01 using AlphaSim). The sON patients showed significantly increased ALFFs in the left caudate and certain regions in the frontal lobes (i.e., medial frontal gyrus), whereas the rON patients showed increased ALFFs in the bilateral inferior temporal gyrus and left medial frontal gyrus (corrected p < 0.01 using AlphaSim). Significantly decreased ALFFs were observed in the right inferior parietal lobule (IPL), left posterior cingulate and precuneus in the rON patients compared with those in the sON patients (corrected p < 0.01 using AlphaSim). Significant correlations were observed between the disease duration and ALFF in the left middle temporal gyrus, left inferior occipital gyrus, right lingual gyrus and right IPL (p < 0.05).
Conclusion: Functional impairment and adaptation occurred in both the sON and rON patients. Impairment mainly involved the occipital cortex, and functional adaptions predominantly occurred in the frontal lobe. Functional damage was more severe in the rON patients than in the sON patients and correlated with the disease duration.
... Optic neuritis is an optic nerve inflammatory disorder primarily an isolated phenomenon or secondarily associated with other neurological defects such as neuromyelitis optica or multiple sclerosis or infectious processes such as local or systemic viral infections [1][2][3][4]. Some types of optic neuritis may be also resembled by genetic disorders or by neuropathies with unknown origins [4,5]. ...
... Optic neuritis is defined as an inflammation and demyelination of the optic nerve [1] [2]. ...
... The pathogenesis of optic neuritis is not entirely understood [2]. ...
... RAPD may not be present if there is symmetric involvement or prior history of optic neuropathy in the fellow eye [12]. Four to six weeks after onset of inflammation, optic disc pallor usually develops [2]. All these symptoms were evident in our patient. ...
Objective: To report a rare case of multiple episodes of optic neuritis exacerbation in pregnancy
... Leading symptoms include reduced visual acuity, visual field defects, periocular pain-especially during eye movement-, reduced contrast sensitivity and dysfunction of color vision [1][2][3]. ON is typically diagnosed in young adults aging 20-45 years, with women being three times more often affected than men [4,5]. The etiology of acute demyelinating ON is commonly idiopathic or autoimmune. ...
... The etiology of acute demyelinating ON is commonly idiopathic or autoimmune. In addition, toxic, nutritional, metabolic, vascular, hereditary, infectious, infiltrative, or compressive conditions may lead to similar symptomatology [1,2,4,6]. In 15-25 percent of patients suffering from multiple sclerosis (MS), ON is the first clinical event and 50-60 percent develop ON at some point during disease course [7][8][9][10]. ...
Background
In acute optic neuritis, magnetic resonance imaging (MRI) may help to confirm the diagnosis as well as to exclude alternative diagnoses. Yet, little is known on the value of optic nerve imaging for predicting clinical symptoms or therapeutic outcome.
Purpose
To evaluate the benefit of optic nerve MRI for predicting response to appropriate therapy and recovery of visual acuity.
Methods
Clinical data as well as visual evoked potentials (VEP) and MRI results of 104 patients, who were treated at the Department of Neurology with clinically definite optic neuritis between December 2010 and September 2012 were retrospectively reviewed including a follow up within 14 days.
Results
Both length of the Gd enhancing lesion (r = -0.38; p = 0.001) and the T2 lesion (r = -0.25; p = 0.03) of the optic nerve in acute optic neuritis showed a medium correlation with visual acuity after treatment. Although visual acuity pre-treatment was little but nonsignificantly lower if Gd enhancement of the optic nerve was detected via orbital MRI, improvement of visual acuity after adequate therapy was significantly better (0.40 vs. 0.24; p = 0.04). Intraorbitally located Gd enhancing lesions were associated with worse visual improvement compared to canalicular, intracranial and chiasmal lesions (0.35 vs. 0.54; p = 0.02).
Conclusion
Orbital MRI is a broadly available, valuable tool for predicting the improvement of visual function. While the accurate individual prediction of long-term outcomes after appropriate therapy still remains difficult, lesion length of Gd enhancement and T2 lesion contribute to its prediction and a better short-term visual outcome may be associated with detection and localization of Gd enhancement along the optic nerve.
... The term optic neuritis (ON) refers to inflammation of the optic nerve due to many causes, indicated by sub-acute unilateral painful visual loss mostly in a young healthy female and by excluding glaucoma, ON is the most common optic neuropathy in persons under 50 years coming to general ophthalmic practice. It is the earliest clinical symptom in about 20% of cases of MS [1] [2] [3] [4] [5]. ...
... [2] [5] [8] [14] ...
... The classic triad for diagnosis of ON is visual loss, periocular pain and dyschromatopsia [2] [5] [9]. Optic neuritis can have long-lasting effects on visual motion processing regardless of temporary effects on visual form processing. ...
The aim of this review is to summarize the latest information about optic neuritis, its differential diagnosis and management. Optic Neuritis (ON) is defined as inflammation of the optic nerve, which is mostly idiopathic. However it can be associated with variable causes (demyelinating lesions, autoimmune disorders, infectious and inflammatory conditions). Out of these, multiple sclerosis (MS) is the most common cause of demyelinating ON. ON occurs due to inflammatory processes which lead to activation of T-cells that can cross the blood brain barrier and cause hypersensitivity reaction to neuronal structures. For unknown reasons, ON mostly occurs in adult women and people who live in high latitude. The clinical diagnosis of ON consists of the classic triad of visual loss, periocular pain and dyschromatopsia which requires careful ophthalmic, neurologic and systemic examinations to distinguish between typical and atypical ON. ON in neuromyelitis optica (NMO) is initially misdiagnosed as ON in MS or other conditions such as Anterior Ischemic Optic Neuropathy (AION) and Leber's disease. Therefore, differential diagnosis is necessary to make a proper treatment plan. According to Optic Neuritis Treatment Trial (ONTT) the first line of treatment is intravenous methylprednisolone with faster recovery and less chance of recurrence of ON and conversion to MS. However oral prednisolone alone is contraindicated due to increased risk of a second episode. Controlled High-Risk Subjects Avonex(®) Multiple Sclerosis Prevention Study "CHAMPS", Betaferon in Newly Emerging Multiple Sclerosis for Initial Treatment "BENEFIT" and Early Treatment of MS study "ETOMS" have reported that treatment with interferon β-1a,b results in reduced risk of MS and MRI characteristics of ON. Contrast sensitivity, color vision and visual field are the parameters which remain impaired mostly even after good recovery of visual acuity.
Background
The most common demyelinating disease of the central nervous system is multiple sclerosis (MS), which is considered an acquired chronic progressive inflammatory process. Overall, 25% of the patients have an optic neuritis (ON) as a first neurological presentation.
Aim
To evaluate optic nerve head microcirculation in patients with MS without ON by using an optical coherence tomography angiography (OCTA).
Patients and methods
Our prospective study included 50 patients divided into two groups: patient group, which included 25 patients with relapsing-remitting MS without ON, and control group, which included 25 healthy participants matched with patient group regarding age and sex.
Results
The mean for average ganglion cell complex, average retinal nerve fiber layer thickness, and whole image retinal peripapillary capillary density % was 84.56±15.60, 80.64±21.89, and 46.42±5.48, respectively, for the patients group, whereas it was 95.84±5.13, 105.56±4.27, and 50.72±2.93, respectively, for the control group, and the differences between the two groups were highly statistically significant.
Conclusion
Significant decreases in vessel density and perfusion of optic nerve vasculature are evidenced in OCTA in patients with MS without ON in comparison with the normal control. So, OCTA is considered a promising paraclinical technology that can aid in early diagnosis of ON in MS for better management.
Optic neuritis (ON) is an inflammatory condition affecting the optic nerve, leading to vision impairment and potential vision loss. This manuscript aims to provide a comprehensive review of the current understanding of ON, including its definition, epidemiology, physiology, genetics, molecular pathways, therapy, ongoing clinical studies, and future perspectives. ON is characterized by inflammation of the optic nerve, often resulting from an autoimmune response. Epidemiological studies have shown a higher incidence in females and an association with certain genetic factors. The physiology of ON involves an immune-mediated attack on the myelin sheath surrounding the optic nerve, leading to demyelination and subsequent impairment of nerve signal transmission. This inflammatory process involves various molecular pathways, including the activation of immune cells and the release of pro-inflammatory cytokines. Genetic factors play a significant role in the susceptibility to ON. Several genes involved in immune regulation and myelin maintenance have been implicated in the disease pathogenesis. Understanding the genetic basis can provide insights into disease mechanisms and potential therapeutic targets. Therapy for ON focuses on reducing inflammation and promoting nerve regeneration. Future perspectives involve personalized medicine approaches based on genetic profiling, regenerative therapies to repair damaged myelin, and the development of neuroprotective strategies. Advancements in understanding molecular pathways, genetics, and diagnostic tools offer new opportunities for targeted therapies and improved patient outcomes in the future.
