The epidemiology, pathophysiology, clinical features, and diagnosis of optic neuritis are discussed separately. Pain or pain with eye movement isnt a consistent feature of pediatric optic neuritis. The groundbreaking discovery of a novel, pathogenic autoantibody termed nmoigg or aqp4ab in a subset of patients by dr lennon and colleagues in 2004 4, 5 has led to a tremendous increase in. Infectious neuritis is secondary to different microorganisms bacteria, virus, fungi, or. Nmo was originally described in 1894 by eugene devic, but sir thomas clifford allbutt had. Neuritis optica diagnostico y tratamiento mayo clinic. The discovery of autoantibodies aqp4igg that target. Jun 23, 2015 entrevista a especialista en neuropediatria del insn brena. Distinguishing optic neuritis in neuromyelitis optica spectr. Pediatric optic neuritis may present as a clinically isolated syndrome or in the setting of underlying neurologic disease. Totally 128 patients with optic neuritis resulted from varied causes were treated in the neuro ophthalmology of the general hospital of chinese peoples liberation army pla from february 2011 to november 2012.
The capilary arteries entering into the retinae are so tyni that they resembled the susac mycroagiopahy this is probably due to the paroxistic activity of neuronal circuits that could stimulate the endothelial cells of. Neuritis optica oftalmologia clinica y experimental. Neuromyelitis optica an overview sciencedirect topics. If the optic neuritis is not caused by a systemic illness, all of the symptoms you may have will be around the eye. The findings of the ontt, reported in more than 50 publications during the past 20 years, have numerous implications. Although the visual prognosis is excellent in the majority of cases, many patients develop pathology, such as. Uhthoffs symptom may continue, even after the optic neuritis has resolved. Optic neuritis after infliximab therapy springerlink. Nmo accounts for a small proportion of demyelinating disease in caucasians 12%, but a much larger percentage in asians 2048% kira, 2003. The term optic neuritis on refers to inflammation of the optic nerve due to many causes, indicated by subacute 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. Summary optic neuritis remains one of the most common initial manifestations of ms, although a number of other causes of visual impairment are possible even in the patient. Exciting developments have occurred over the past decade in understanding of optic neuritis pathophysiology, and these developments have been translated into treatment trials.
Dec 18, 20 totally 128 patients with optic neuritis resulted from varied causes were treated in the neuro ophthalmology of the general hospital of chinese peoples liberation army pla from february 2011 to november 2012. The groundbreaking discovery of a novel, pathogenic autoantibody termed nmoigg or aqp4ab in a subset of patients by dr lennon and colleagues in 2004. In this article, the authors report a 53yearold woman with refractory rheumatoid arthritis that developed neuritis optica after the fourth dose of infliximab and had a good outcome after antitnf withdrawal, associated. Optic neuritis and the eeg, is interesting due to the rapid recovery and the abnormal findings of the eeg. In the past decade, the disease phenotypes for demyelinating syndromes in children have been more clearly defined. However, if you have a systemic autoimmune disease, you may experience other symptoms. Infectious neuritis is secondary to different microorganisms bacteria, virus, fungi, or protozoa. Optic neuritis may be monophasic, recurrent, or part of a polysymptomatic demyelinating process. Neuromyelitis optica nmo, also known as devics disease, is an uncommon immunemediated syndrome characterized by unilateral or bilateral optic neuritis and transverse myelitis with rare pathologic involvement beyond the optic nerves and spinal cord. Distinguishing optic neuritis in neuromyelitis optica. The aim of the treatment is to reduce number and severity of attacks and prevent future disability.
Full text optic neuritis as an early sign of multiple. The optic neuritis treatment trial ontt has had a highly significant impact on the practices of ophthalmology and neurology. In the united states, optic neuritis occurs more commonly in caucasians than in africanamericans. Visual pathway abnormalities were found in most multiple sclerosis patients despite history of previ. In the united states, patients of african descent are also overrepresented.
It is highly associated with multiple sclerosis ms, occurring in 50 percent of individuals at some time during the course of their illness. Neuropatia optica isquemica anterior no arteritica. Optic neuritis is an inflammatory, demyelinating condition that causes acute, usually monocular, visual loss. Treatment of optic neuritis by plasma exchange addon in. Optic neuritis is the presenting feature of ms in 15 to 20 percent of patients. Abstract inflammatory optic neuritis on is the most frequent cause of acute visual loss in young adults.
Neuropatia optica inflamatoria recurrente cronica crion. Optic neuritis and the evaluation of visual impairment in. Optic neuritis, its differential diagnosis and management. Optic neuritis on is a demyelinating inflammation of the optic nerve that typically first occurs in young adulthood see the image below. Optic neuritis and the evaluation of visual impairment in mu. Objective to assess the contribution of plasma exchange pe in association addon with pulsed intravenous corticosteroids in acute optic neuritis of neuromyelitis optica nmo and limited forms of nmo methods thirtysix patients with optic neuritis were treated from january 1, 1995, through december 31, 2010, with pulsed intravenous corticosteroids and 16 with pulsed intravenous. Subacute sclerosing panencephalitis presenting as neuromyelitis optica.
Demyelinating diseases were described in patients receiving antitnf agents. Apr 10, 2018 pain or pain with eye movement isnt a consistent feature of pediatric optic neuritis. The retinal nerve fiber layer of patients with neuromyelitis optica and chronic relapsing optic neuritis is more severely damaged than patients with multiple sclerosis. In its typical form, optic neuritis presents as an inflammatory demyelinating disorder of the optic nerve, which can be associated with. Although the debate continues over the use of intravenous steroids in the management of acute optic neuritis to modify shortterm risk of ms in patients with highrisk magnetic resonance imaging mri results, there are other important evidencebased conclusions that make the. Distinguishing ischaemic optic neuropathy from optic. Distinguishing ischaemic optic neuropathy from optic neuritis by ganglion cell analysis natalie erlichmalona,1 carlos e. Neuromyelitis optica and aquaporin4 aqp4 autoantibodies.
Many cases of on are associated with multiple sclerosis ms or neuromyelitis optica nmo, but on can occur in isolation. May involve the retrobulbar retrobulbar neuritis or the intrabulbar papillitis portion of the optic nerve, or both. Hedges iii,1 nimesh patel,1 caitlin monaco1 and emily cole1 1new england eye center, tufts university school of medicine, tufts medical center, boston, massachusetts, usa 2dysautonomia center, new york university schools of medicine, nyu. Optic neuritis on induced by tnf blockers was already described in 22 cases in the literature. The purpose of this paper is to present a case of demyelinating optic neuritis and discuss the diagnosis step confrontation. Recent findings the use of optical coherence tomography as both a clinical and research tool has advanced our understanding of how the afferent visual system is affected by ms. Neuromyelitis optica and aquaporin4 aqp4 autoantibodies in. The impact can be attributed to its systematic collection and analysis of enormous amounts of data, adherence to sound clinical trial methodology, as well as important unanticipated findings.
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