Clinical Pathways in Neuro-ophthalmology : An ... - E-Lib FK UWKS

Table 2–3. Features of Atypical Optic Neuritis (ON)
associated with visual recovery; however, a significant number of patients (22%) remain
visually disabled. A normal magnetic resonance (MR) image of the brain may be
associated with a better outcome. Younger patients are more likely to have bilateral
disease and a better visual prognosis (Brady, 1999).
In another study of 47 children with multiple sclerosis, 38 (80.9%) had ON at least
once, and 10 (21.3%) had two or more attacks of ON (Boiko, 2000). The presence of
tumor necrosis factor a7 (TNF-a7) locus on chromosome 6 was proposed as a possible
marker of early multiple sclerosis (MS) onset in these patients.
What Is the Evaluation of Optic Neuritis?
Optic Neuritis 39
Bilateral simultaneous onset of ON in an adult patient
Lack of pain
Severe headache (e.g., sphenoid sinusitis)
Ocular findings suggestive of an inflammatory process
Anterior uveitis
Posterior chamber inflammation more than trace
Macular exudate or star figure
Retinal infiltrate or retinal inflammation
Severe disc swelling
Marked hemorrhages
Lack of significant improvement of visual function or worsening of visual function after 30 days
Lack of at least one line of visual acuity improvement within the first 3 weeks after onset of
symptoms
Age greater than 50 years
Preexisting diagnosis or evidence of other systemic condition
Inflammatory (e.g., sarcoidosis, Wegener’s granulomatosis, systemic lupus erythematosus)
Infectious disease (e.g., Lyme disease, tuberculosis, human immunodeficiency virus infection)
Severe hypertension, diabetes, or other systemic vasculopathy
Exquisitely steroid sensitive or steroid-dependent optic neuropathy
In atypical cases, consideration should be given to doing a lumbar puncture and
additional laboratory studies; in the ONTT, syphilis serology, antinuclear antibody,
and chest x-ray were performed. The required evaluation depends on the history and
examination, with specific attention to infectious or inflammatory etiologies as listed in
Table 2–4. In addition, patients with inflammatory autoimmune ON often have
progressive or recurrent steroid-responsive or steroid-dependent optic neuropathy
(Beck, 1994a; Bielory, 1993; Riedel, 1998).
The association of acute or subacute loss of vision in one or both eyes caused by optic
neuropathy preceded or followed by a transverse or ascending myelopathy is referred
to as neuromyelitis optica (Devic’s disease). The clinical features of Devic’s disease are
outlined in Table 2–6.