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Abstract
Optic neuromyelitis is a disease caused by autoimmune disruption of the aquaporin 4 channels of central nervous system, whose involvement is more frequent over the spinal cord and optic nerves as well as in specific areas of the brain. Optic neuritis in optic neuromyelitis can occur simultaneously with transverse myelitis or separated by a variable time interval of days or even years. It may be unilateral or bilateral and could occur in recurrent forms. We describe a 35-year-old woman with visual loss due to acute bilateral optic neuritis and a 46-year-old woman with unilateral optic neuritis that were admitted at the neuro- ophthalmology service of the Cuban Ophthalmology Institute last year. Both were treated with intravenous methylprednisole for five days. Three month later neurologic symptoms appeared, a magnetic resonance imaging was performed and the optic neuromyelitis diagnosis was confirmed. We show the results of the neuro-ophthalmology studies before and three month after the treatment.
Highlights
Optic Neuromyelitis (ONM) is a disease caused by autoimmune disruption of the aquaporin 4 channels (AQ4P) of central nervous system (CNS), whose involvement is more frequent over the spinal cord and optic nerves as well as in specific areas of the brain
Optic neuritis in ONM can occur simultaneously with transverse myelitis or separated by a variable time interval of days or even years. It may be unilateral or bilateral and it could occur in recurrent forms, but few articles give a specific approach of the morphological characteristics of the optic nerve head in ONM
AQP4 is expressed on the abluminal surface of endothelial cells in unfenestrated capillaries from the CNS, as well as in the astrocytic end feet that supply the tight junction of the blood–brain barrier
Summary
Optic Neuromyelitis (ONM) is a disease caused by autoimmune disruption of the aquaporin 4 channels (AQ4P) of central nervous system (CNS), whose involvement is more frequent over the spinal cord and optic nerves as well as in specific areas of the brain. Optic neuritis in ONM can occur simultaneously with transverse myelitis or separated by a variable time interval of days or even years. A healthy woman of 46 years old was presented to our clinic with vision loss in the right eye associated with pain at eye movements Her ocular history included high myopia that was partially corrected with radial keratectomy 20 years ago. The visual field (VF) in figure 3 had a scotoma in RE and the VEP showed significant delays in the P100 response with normal amplitudes in LE. The patient returned to our clinic complaining of acute urinary retention and complete transverse myelitis, but improved visual function in the right eye with BCVA 0.0 (LogMAR units), CS 1.50 and CV 21. Dilated fundus examination (Figure 8) in both eyes showed significant attenuation of arterioles with changes in vascular retinal walls (white arrow) and bilateral optic disc atrophy
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