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ABSTRACT.Purpose: The goal of our study was to compare the case histories and clinical findings in three young patients (aged <50 years) who had undergone their first attack of non-arteritic ischaemic optic neuropathy (NAION). We intended to consider whether NAION at a relatively young age might comprise a separate pathological and diagnostic entity. Results: All three cases revealed some common characteristics. All of them experienced recurrent attacks with bilateral manifestations that led to severe loss of vision and visual field defects. The patients had also suffered from diabetes mellitus for a long time, but none of them had diabetic retinopathy. Conclusion: The case histories of these relatively young patients showed some differences, including recurrences and more severe loss of vision, to those of elderly patients. However, all the signs we found had been reported previously, although much less frequently, in NAION cases among elderly patients. The clinical and laboratory findings definitely exclude the possibility of an alternative diagnosis. Hence, our results do not support the notion of a different pathomechanism of NAION at a young age and its existence as a separate disease entity.

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Is there a relationship?I t became clear in the last decades that neuropathy is not a separate clinical entity, but a component of several related complications (1). Although the functional consequences of neuropathy are well defined in various organ systems, the relationship of the alterations in the networks of the neuronal system is still poorly documented. Assessment of the potential common alterations of the different neuronal functions in patients with diabetic neuropathy may provide new pathogenetic and diagnostic considerations. Previously, we observed correlations between the delay of certain auditory-evoked potentials and the severity of autonomic and peripheral sensory neuropathy in patients with type 1 diabetes (2). In addition, we found a relationship between the latency of visual-evoked potentials and the peripheral neuronal function (3). The aims of this study were to analyze the possible correlations between the central auditory and visual afferentations and the severity of autonomic and sensory neuropathy in patients with long-standing type 1 diabetes.A total of 10 middle-aged type 1 diabetic patients with long-standing diabetes were included in the study (4 male and 6 female subjects aged 43.8 Ϯ 15.2 years [mean Ϯ SD], duration of diabetes 23.1 Ϯ 9.3 years, BMI 27.9 Ϯ 3.9 kg/m 2 ). Patients with abnormal hearing, proliferative retinopathy, impaired visual acuity, or neuropathy of origin other than diabetes were excluded. The quantitative characteristics of the brainstem function were evaluated by the detection of auditoryevoked potentials after the delivery of an audible click of short duration via an earphone (4). The latencies of the first five waves (I-V) were analyzed in this study.The central afferent visual function was evaluated via the delay of the major positive component (P100) of the visualevoked potentials that was generated following a pattern-reversal checkboard stimulation (5). Cardiovascular autonomic function was assessed by means of the five standard cardiovascular reflex tests (2,3,6). The heart rate tests (the heart rate response to deep breathing, the 30:15 ratio, and the Valsalva ratio) mainly reflect the parasympathethic function, whereas the systolic blood pressure response to standing up and the diastolic pressure change to a sustained handgrip predominantly characterize the sympathetic integrity. Detection of current perception thresholds (CPTs) with a neuroselective transcutaneous stimulator, the Neurometer (Neurotron, Baltimore, MD), allowed for the assessment of the sensory function at three different frequencies on the median and peroneal nerves (6). The analysis of the auditoryevoked potentials revealed negative relationships between the heart rate tests and the prolongation of the latencies of waves III and V (heart rate response to breathing-wave III, r ϭ Ϫ0.586, P Ͻ 0.01; 30:15 ratio-wave III, r ϭ Ϫ0.588, P Ͻ 0.01; heart rate response to breathingwave V, r ϭ Ϫ0.498, P Ͻ 0.05; Valsalva ratio-wave V, r ϭ Ϫ0.463, P Ͻ 0.05; and 30:15 ratio-wave V, r ϭ Ϫ0.599, P Ͻ 0...

The purpose of this paper was to provide evidence for the reintroduction of simultaneously performed fluorescein angiography and electroretinography in the detection of diabetic retinopathy. ERG observations were made in conjunction with fluorescein angiography of 13 patients suffering from type I diabetes mellitus for five to 13 years. Only patients without any fluorescein leakage during angiography and without any morphologic changes in the fundus were involved in the study. Gold foil electrodes were used for recording. A stroboscopic lamp provided flashing light stimulation through a monochromatic blue filter. Intravenous fluorescein administration caused an immediate reduction in the ERG response. This reduction was seen both in the control subjects and in diabetes patients. In the control group, the reduction was over in 30-45 min, while in the diabetes group a considerable amplitude elevation was seen in all recordings between 15 and 60 min post-fluorescein. In the adaptation control group, where only repeated ERG recordings were employed every 15 min, a slight decrease in the a wave and a slight elevation of the b wave were observed during the whole recording period. No complaints or side-effects were detected during the observations. As all the patients displayed a normal fluorescein angiography besides elevated b wave after fluorescein administration, and this elevation was seen exclusively in the diabetic group, our study raises the possibility that this diagnostic method can be used in the detection of diabetic retinopathy.