Presentation Of Optic Neuritis Research Articles

Lactational optic neuritis - A case series with review of the literature.

Optic neuritis is the most common optic neuropathy affecting adults, especially women. Lactational optic neuritis is a rare entity occurring during the postpartum period with a high chance of recurrence. Through this study, we evaluated the clinical profile and visual outcome of lactational optic neuritis. This was a retrospective study where patients with optic neuritis presenting during the first year of the postpartum period to the neuro-ophthalmology clinic between January 2016 and December 2022 were included in the study. This study included seven eyes of six patients. The mean age of presentation was 24.6 years, with all patients presenting after the first 3 months of the postpartum period. All patients had unilateral involvement except one, presenting with painful vision loss. Best corrected visual acuity ranged from 6/18 to hand movements. Relative afferent pupillary defect and dyschromatopsia were present in all patients. Disc edema was seen in all but one case. Three patients were treated with steroids along with multivitamins, and the remaining three refused treatment with steroids, receiving multivitamins alone. All patients had complete recovery by the end of 12 weeks. Optic neuritis during lactation is attributed more to post-pregnancy immunological changes rather than lactation itself. The presentation and clinical features are similar to classic optic neuritis and remain an important differential diagnosis for visual dysfunction in the postpartum period.

Cat’s Meow: A Triad of Optic Neuritis, Iritis, and a Parotid Mass

Cat Scratch Disease is an infectious process caused by the bacteria Bartonella henselae. It classically presents as a self-limited lymphadenopathy after inoculation through a cat scratch. This case details an atypical presentation of optic neuritis, iritis, and a parotid mass. The purpose of this discussion is to promote inclusion of Cat Scratch Disease in the diagnostic workup of a pediatric patient presenting with these symptoms.

Clinical and Radiologic Features of a Cohort of Adult and Pediatric Patients in the Pacific Northwest with Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD) (P13-5.022)

<h3>Objective:</h3> To describe a cohort of patients with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) seen at a tertiary center in the pacific northwest. <h3>Background:</h3> MOGAD is a newly described clinical entity comprised of various presentations of optic neuritis, transverse myelitis, acute disseminated encephalomyelitis (ADEM), encephalitis, and seronegative NMOSD. Patients may sustain only one attack or have a relapsing course necessitating immunotherapy for relapse prevention. Prior reports note that MOGAD is more commonly monophasic in children (up to 70%), though 30–80% of children and adults with MOGAD will go on to have relapses and there is no way to predict who is at risk. <h3>Design/Methods:</h3> This was a single-center retrospective cohort study. <h3>Results:</h3> This preliminary sample consisted of 56 patients (20 pediatric, 36 adult) with a diagnosis of MOGAD evaluated at least once at our center between January 2017 and October 2022. Non-Hispanic White (55.4%) and Hispanic (30.4%) comprised the majority of the sample. The median age during index event was 9.27 years in the pediatric subset and 36.1 in the adults. Amongst the whole cohort, the most common presentation at onset was optic neuritis (58.9%) though the majority of pediatric cases presented with (ADEM) (40.0%). The pediatric group had more patients with relapsing disease (70.0%) compared to the adult group (55.6%). Half of relapsing pediatric patients had their first relapse more than a year after the index event with a median time to first relapse of 15.5 months. The median time to first relapse in the adult group was 7.0 months. None of the patients in the pediatric group were started on immunotherapy for relapse prevention prior to the first relapse though a subset of adult patients were (19.4%). <h3>Conclusions:</h3> This study is the first to describe the demographic and clinical features of a unique sample of patients with MOGAD evaluated in the pacific northwest. <b>Disclosure:</b> Dr. Martin has received research support from Tartar Trust. The institution of Dr. Martin has received research support from OHSU Foundation. Mrs. Srikanth has nothing to disclose. Dr. Angappan has nothing to disclose. Miss Srikanth has nothing to disclose. Dr. Kanwar has nothing to disclose. Miss Mazmanyan has nothing to disclose. Julie Falardeau has nothing to disclose. David Pettersson has nothing to disclose. Dr. Yadav has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Janssen Pharmaceuticals. Dr. Yadav has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bristol Myers Squibb Foundation. Dr. Yadav has received personal compensation in the range of $500-$4,999 for serving as a Consultant for EMD-Serono . The institution of Dr. Yadav has received research support from Department of Veterans Affairs. Dr. Yadav has received research support from NIH. Dr. Yadav has received research support from PCORI. Dr. Yadav has received research support from NMSS. The institution of Dr. Yadav has received research support from Department of Veterans Affairs. The institution of Dr. Yadav has received research support from Tykeson Family Foundation Endowed Professorship.

Widespread retinal hemorrhages in a patient with atypical optic neuritis

Retinal hemorrhages are rare in optic neuritis. We report a case of atypical optic neuritis with widespread retinal hemorrhages. A 30-year-old Indian woman presented with sudden painful and severe visual loss in the left eye for 3 days. Fundus examination showed minimal optic disk edema associated with intraretinal hemorrhages extending to the periphery in the left eye. On neuroimaging, long segment thickening of the intraorbital segment of the left optic nerve was appreciated with T2 hyperintensity. Serum myelin oligodendrocyte (MOG) antibodies and neuromyelitis optica (NMO) antibodies were negative. Visual acuity improved rapidly after the administration of intravenous high-dose steroids, and fundus abnormalities resolved rapidly. Retinal hemorrhages can also be present in atypical optic neuritis in the absence of severe optic disk edema. Clinicians should be mindful of the variable presentations of optic neuritis to initiate proper and timely treatment.

Acute-onset bilateral visual loss in the context of longstanding myasthenia gravis: don’t forget anti-aquaporin-4 antibodies!

Acute-onset visual loss is a medical emergency necessitating prompt and timely intervention to preserve vision and prevent further deterioration. Besides ocular pathologies, neurological conditions account for a significant proportion of cases of visual loss, particularly optic nerve pathologies including demyelinating or inflammatory optic neuritis. Inflammatory optic neuritis may cause unilateral or bilateral acute visual loss in isolation, as the first presentation of multiple sclerosis or neuromyelitis optica spectrum disorder, or in association with systemic autoimmune conditions. We hereby present a case of sequential bilateral anti-aquaporin-4 autoantibody-positive optic neuritis presenting as acute bilateral visual loss and initially diagnosed as temporal arteritis in a patient with longstanding myasthenia gravis. Our case highlights the importance of timely recognition of the possibility of optic neuritis when assessing acute visual loss, and the need for prompt initiation of corticosteroid therapy for residual vision preservation. It also illustrates the importance of maintaining awareness of possible neuromyelitis optica spectrum disorders and diligently testing for anti-aquaporin-4 antibodies in patients presenting with ocular symptoms in the context of co-existing autoimmune pathology and no other obviously attributable ophthalmological pathologies.

Case Report: Neuromyelitis Optica Spectrum Disorder With Progressive Elevation of Cerebrospinal Fluid Cell Count and Protein Level Mimicking Infectious Meningomyelitis: A Diagnostic Challenge

Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune-mediated idiopathic inflammatory demyelinating disease with a typical clinical presentation of optic neuritis, acute myelitis, and area postrema syndrome. Most NMOSD patients are seropositive for disease-specific and pathogenic aquaporin-4 (AQP4) antibodies, which are key markers for the NMOSD diagnosis. Herein, we report an atypical case of a 41-year-old man who complained of intractable hiccups and vomiting at disease onset, followed by fever, headache, back pain, progressive paresthesia, and weakness of extremities later on. Magnetic resonance imaging revealed longitudinally extensive transverse myelitis. Cerebrospinal fluid analysis showed progressive increases in the white blood cell count and the protein level, which were accompanied by the deterioration of clinical manifestations. The patient was initially suspected of infectious meningomyelitis but was finally diagnosed with NMOSD. This case with distinct cerebrospinal fluid findings broadens the phenotypic spectrum of NMOSD. Furthermore, it also highlights the clinical value of AQP4 antibody test for early definitive diagnosis and proper treatment.

Optic Neuritis: A Brief Overview

The optic nerve carries information from the retina to the visual pathways in the brain. Optic neuritis is inflammation of the optic nerve, which can be associated with various aetiologies including demyelinating lesions, autoimmune conditions, infections and other inflammatory processes. This article discusses the clinical presentation of optic neuritis as well as pathogenesis, investigation and management.

Acute unilateral decrease in vision on initial presentation of an adolescent female in the emergency department

Background: Optic neuritis is an acute demyelinating inflammation of the optic nerve that leads to acute loss of vision and eye pain worsened with eye movement. It is a relatively rare condition in the pediatric population. Pediatric optic neuritis usually arises following a viral illness. It can present as an initial feature of a systemic demyelinating disease such as multiple sclerosis or neuromyelitis optica, but can also occur as an isolated syndrome. We report a classic presentation of optic neuritis presented to our Emergency Department in Doha, Qatar. Case presentation: A 16-year-old female adolescent, of Asian descent, with no past medical history, presented with acute decrease in vision in her left eye associated with eye pain and mild headache for the past week. There were no other associated symptoms. Vital signs, systemic and neurologic examinations were normal. Pertinent ophthalmologic findings on her left eye examination were as follows: visual acuity: counting fingers at 3 meters aided, color vision 0/15; normal intra-ocular pressure, slight ptosis; sluggish pupil with relative afferent pupillary defect and funduscopy showing hyperemic optic disc with blurring of the nasal margin, normal macula and retinal vessels. Laboratory reports were unremarkable. Head computed tomography (CT) scan showed asymmetric thickening of the left optic nerve with subtle surrounding fat stranding. Brain and spinal cord magnetic resonance imaging (MRI) showed left optic nerve increased signal and thickness in the proximal segment and contrast enhancement in the optic nerve and optic nerve sheet . Lumbar puncture was done. Cerebrospinal fluid (CSF) analysis and culture showed unremarkable results. The patient was admitted with a working diagnosis of optic neuritis for further investigations. Conclusion: The patient fully recovered after receiving steroid treatment for 5 days and was discharged subsequently. Optic neuritis can be seen among young patients, often female, with classic presentation of acute loss of vision and eye pain. It can be the primary manifestation of a chronic demyelinating process.

Atypical presentation of optic neuritis with unilateral inferior altitudinal visual field defect in multiple sclerosis

Background: The purpose of this paper was to report a case of retrobulbar optic neuritis as the first manifestation of multiple sclerosis, with atypical presentations which include a sudden painless reduction in vision, without optic disc swelling and presence of unilateral inferior altitudinal visual field defect. Case report: A 17-year-old girl presented to our clinic with right eye sudden painless drop in visual acuity to counting finger associated with headache. Her right eye optic nerve function tests were positive, but her optic disc was not swollen. Bjerrum’s visual field chart noted right eye unilateral inferior altitudinal visual field defect with foveal involvement. Her blood investigations were normal, and magnetic resonance imaging (MRI) of brain and orbit was suggestive of multiple sclerosis. She was commenced on three days of high dose intravenous steroi, and was referred to neuromedical team for further management. At 3-month follow up, her right eye visual acuity improved to 6/6 with the restoration of normal colour vision. Conclusions: In presence of atypical presentation of optic neuritis, multiple sclerosis must be thought of especially in young patients. Hence early co-management with neuromedical discipline is important to reduce the frequency and severity of attacks in the future.

Anti-Myelin Oligodendrocyte Glycoprotein Optic Neuritis Presenting with Dense Premacular Hemorrhage

Anti-Myelin Oligodendrocyte Glycoprotein Optic Neuritis Presenting with Dense Premacular Hemorrhage

Eye care in the community: Part 10 – Optic neuritis

This month, community-based optometrist Kirit Patel describes two different presentations of optic neuritis

Treatment of neuromyelitis optica spectrum disorders.

This review discusses concepts for diagnosing neuromyelitis optica spectrum disorders (NMOSD), distinguishing NMOSD from other inflammatory diseases of the central nervous system, and highlights recent and forthcoming data on acute and maintenance therapy of NMOSD. The neurologic manifestations of NMOSD are heterogenous, extending beyond classic presentations of optic neuritis and longitudinally extensive transverse myelitis. NMOSD may be comorbid with rheumatologic diseases, such as systemic lupus erythematosus, but is recognized as a distinct entity. Recent studies of acute treatment of NMOSD support early use of plasmapheresis. Relapse prevention is essential, as relapses can be disabling and patients may have only partial recovery. Current practice generally recommends at least 5 years of maintenance treatment. Recent randomized data demonstrates superiority of rituximab over azathioprine. Phase 3 trials have recently been completed or are underway studying novel therapies employing B-cell depletion, complement inhibition, and cell-based mechanisms (among other mechanisms) for maintenance therapy of NMOSD. NMOSD is a heterogeneous but well-defined clinical entity, distinct from other neurologic and systemic inflammatory diseases, and treatment is poised for expansion.

Adult-onset bilateral optic neuritis: a rare presentation

&lt;p class="abstract"&gt;A rare case of adult-onset bilateral optic neuritis without associated autoimmune or infectious disorders has been reported in this study. A 19-year-old male described sudden bilateral diminution of vision (sequential) with headache with no other remarkable history. Ophthalmological findings revealed asymmetrically reduced visual acuity on the initial visit. Fundus examination showed nerve fibre layer oedema (more in right eye). Radiological examination was suggestive of bilateral, asymmetrical optic neuritis. Visual evoked potential tests suggested asymmetrical and sequential P100 delay. No auto-immune/infectious aetiology was found. The condition was diagnosed as an atypical presentation of optic neuritis with sequential bilateral involvement. Patient was treated with intravenous methyl prednisolone followed by tapering oral doses owing to the bilaterality of the involvement. A careful follow-up is being performed. The condition involving bilateral inflammation of the optic nerves can have hazardous outcome and hence prompt, careful and comprehensive diagnostic and treatment approach is necessitated.&lt;/p&gt;

Updates and Controversies in the Management of Acute Optic Neuritis.

Optic neuritis remains a common diagnosis with controversial management. Although typical optic neuritis is often associated with "good" recovery of visual acuity, patients are often left with persistent impairments of contrast sensitivity, color vision, and visual field. These permanent visual deficits correlate with structural injury to the anterior visual pathway and are closely linked to visual quality of life. High dose corticosteroids are commonly used for patients with acute optic neuritis. However, even several decades after the initial clinical trials, there remains significant controversy regarding the efficacy and utility of this treatment. There is a need for more effective treatments, and many new immunomodulatory and neuroprotective agents have been investigated recently. Atypical optic neuritis, such as that seen with neuromyelitis optica spectrum disorder, often requires more aggressive initial treatment. Thus, it is important for clinicians to have a framework for rapid diagnosis and triage of patients who present with typical or atypical optic neuritis. Lastly, optic neuritis is associated with an elevated long-term risk of developing multiple sclerosis. Some patients may benefit from initiation of medications targeting multiple sclerosis at the time of initial presentation of optic neuritis. Appropriate identification and treatment of patients at highest risk of developing multiple sclerosis may help impact their disease course, while limiting exposure to potential adverse effects in patients who are at lower risk and do not require disease-modifying treatment.

Clinical presentation of optic neuritis with autoantibodies anti-myelin oligodendrocyte glycoprotein.

Myelin oligodendrocyte glycoprotein autoantibodies are associated with certain optic neuritis. Little data are known about the specificity of the initial ophthalmologic presentation. A monocentric retrospective study (2013-2017) of all patients diagnosed with myelin oligodendrocyte glycoprotein+ optic neuritis in a tertiary ophthalmologic unit was conducted. The primary objective was to define the clinical ophthalmologic description of the first episode. The secondary objective was to evaluate the evolution and final diagnosis. A total of nine patients were included. There was no female predominance (sex ratio f/m = 0.8). At the first optic neuritis episode, the average age was 39.3 years (17-67 years, standard deviation: 18.4). Initial visual acuity was low (+1.07logMAR, standard deviation: 0.77); 5 eyes out of 15 had visual acuity +2logMAR or worse. Optic neuritis was mostly painful (8/9) and bilateral (6/9) but asymmetric. Optic disk swelling was reported in 9/15 eyes and 7/9 patients and was significantly associated with lower visual acuity in the acute phase (+1.46logMAR, standard deviation: 0.67 vs +0.5, standard deviation: 0.55; p = 0.03). After a mean observation period of 3.3 years (0.6-9.4 years, standard deviation: 3.4), median visual acuity was 0.05logMAR. All five patients were followed up for more than 1 year (5.4 years, standard deviation: 3.2) had 3-8 relapses (mean: 4.4, standard deviation: 2.1; annualized relapse rate: 1.2, standard deviation: 0.9). Final diagnosis was chronic relapsing idiopathic optic neuritis (n = 4), clinically isolated optic neuritis (n = 3), and neuromyelitis optica spectrum disorder aquaporin 4- (n = 2). Myelin oligodendrocyte glycoprotein+ optic neuritis has an atypical clinical presentation compared with multiple sclerosis and neuromyelitis optica spectrum disorder aquaporin 4+. Its evolution is closer to neuromyelitis optica spectrum disorder aquaporin 4+, with a better visual outcome.

Predictive value of 1 month retinal nerve fiber layer thinning for deficits at 6 months after acute optic neuritis

Background: Retinal nerve fiber layer (RNFL) loss occurs with multiple sclerosis and after optic neuritis. Vision or RNFL changes at presentation of optic neuritis are not predictive of outcome, but vision loss at 1 month correlates with vision deficits at 6 months. We hypothesized that RFNL thinning at 1 month would predict RNFL loss at 6 months. Methods: We prospectively studied the RNFL by optical coherence tomography (OCT) and scanning laser polarimetry (SLP), and determined the threshold field mean deviation, in 25 subjects with acute optic neuritis over a 6-month period. RNFL values, including the amount of thinning at 1-month, were correlated with 6-month outcome. Results: Baseline visual performance and RNFL values were similar for eyes grouped by 1 month RNFL thinning. Eyes with 1 month RNFL thinning had greater and significant RNFL thinning at 6 months, for all quadrants by OCT and for the nasal and inferior quadrants by SLP. RNFL thinning by OCT and SLP at 1 month correlated with 6-month OCT (r = 0.58; p = 0.006) and SLP (r = 0.59; p = 0.002) RNFL thinning, respectively. Conclusion: Early RNFL loss at 1 month was predictive of the RNFL thinning at 6 months, which corroborated the importance of the 1-month time point for predicting the outcome of an optic neuritis attack.

Management of optic neuritis as a clinically first event of multiple sclerosis

This article aims to provide a review of demyelinating optic neuritis as a presenting symptom of multiple sclerosis, clinical features, management options, and recent literature. To date, several questions remain to be unsolved relating to the presentation, treatment, and implications of optic neuritis. Although some authors recommend high-dose corticosteroids for the treatment of acute demyelinating optic neuritis, there is still no consensus relating to corticosteroids treatment including the dosage and length of treatment. Studies have shown that the risk of developing clinically definite multiple sclerosis (MS) after presenting with a clinically isolated syndrome including optic neuritis is increased in patients with an abnormal brain MRI. Better diagnostic tools are needed to precisely predict the conversion to MS and the factors influencing disease severity to determine the most appropriate therapeutic paradigm and avoid unnecessary treatment. Management of optic neuritis presenting as a demyelinating first event still remains inconclusive relating to the acute management and long-term treatment. But recent literature suggests high-dose corticosteroids for acute treatment and disease-modifying treatments may be a valuable option for long-term treatment. However, decision is very individualized and is based on the clinical and imaging findings of the patient.

Demyelinating optic neuritis presenting as a clinically isolated syndrome

Background Clinically isolated syndrome (CIS) describes a single, first-occurrence attack caused by inflammation/demyelination in 1 or more locations in the central nervous system. The optic nerve is a frequent site affected by this neurologic event. As the name implies, CIS is an isolated condition but is often considered a precursor to multiple sclerosis (MS). When distinctive brain lesions detected by magnetic resonance imaging (MRI) accompany CIS, the person is considered at a high risk for MS. Treatment is aimed at delaying the onset of a second neurologic episode, reducing the accumulation of MRI-detected brain lesions and delaying the development of definite MS. Case Report This article describes a 40-year-old woman who experienced a sudden loss of vision in the right eye. Testing ultimately found a normal MRI, demyelination of the optic nerve, and progressive thinning of the retinal nerve fiber layer, leading to a diagnosis of CIS.

Magnetic Resonance Imaging in Acute Optic Neuritis in Singapore

The Optic Neuritis Treatment Trial (ONTT) has established that the magnetic resonance imaging (MRI) findings at the time of presentation of optic neuritis (ON) is the strongest indicator of the development of multiple sclerosis (MS). Reports from Singapore as well as other Asian countries have indicated that these abnormalities are less frequently encountered compared to that reported by the ONTT. This paper aims to describe systematically the brain MRI as well as the optic nerve abnormalities in patients after an episode of acute optic neuritis. Patients who presented with acute optic neuritis were retrieved from our prospective optic neuritis study and their MRI scans were reviewed and graded in accordance with the standardised classification employed in the ONTT. Fifteen of 24 patients had MRI brain and optic nerves performed during the acute episode. In the evaluation of brain abnormalities, 40% were classified as grade 0, 20% grade I, 20% grade II, 6.7% grade III and 13.3% grade IV. Optic nerve abnormalities were observed in 80% of cases. At study entry, 10 patients had idiopathic (monosymptomatic) ON, 3 had multiple sclerosis (MS), one each with infective and autoimmune optic neuritis, respectively. The single patient who developed MS at study completion presented with grade II brain abnormalities at the initial MRI. For those with idiopathic ON, our study revealed a higher percentage of grade 0-I brain changes as well as a lower lesion load compared to the ONTT.Lesion Load and grade was also lower in anterior optic neuritis compared with retrobulbar disease. Our study revealed a lower percentage of grade II-IV brain MRI abnormalities as well as less lesion load in idiopathic ON compared to the ONTT. This may be related to the lower prevalence of MS in our predominantly Asian population. As diagnostic tests and understanding of neuromyelitis optica or Devic's disease improves, we may see more patients being diagnosed with this condition, which may also explain our findings. Our data also showed that MRI grade and lesion load in cases of anterior ON was lower than for retrobulbar disease. MRI in ON has an essential role in characterising the disease, evaluating for associated brain lesions, and assessing prognosis in retrobulbar disease but may be less useful in anterior disease.

Optic neuritis presenting with amaurosis fugax

Optic neuritis usually presents with rapid and gradual loss of vision that is either complete or incomplete, and typically associated with retro-orbital pain. To our knowledge there have been no documented reports of optic neuritis presenting with multiple episodes of amaurosis fugax, the sudden and transient loss of vision lasting seconds to minutes. We report here the case of a young woman with a possible diagnosis of demyelinating left optic neuritis that presented solely with multiple episodes of brief and transient sudden loss of vision. Ophthalmological exams were normal between episodes of vision loss. The patient's magnetic resonance imaging of the brain showed a subtle enhancement of the left optic nerve along with multiple periventricular lesions, highly suggestive of a demyelinating disease. The frequent episodes of visual loss resolved completely with high dose parenteral steroids. Neurologists and other clinicians should be aware of this unusual presentation of optic neuritis as treatment modalities differ greatly from other causes of amaurosis fugax.