Atypical features prompting neuroimaging in acute optic neuropathy in adults

Lee, Andrew G.; Lin, Daniel J.; Kaufman, Mathew; Golnik, Karl C.; Vaphiades, Michael S.; Eggenberger, Eric

doi:10.1016/s0008-4182(00)80060-5

Cited by 30 publications

(13 citation statements)

References 10 publications

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“…These determinations are supported by the literature [14,15]. The group concluded that optic neuritis with a normal brain MRI and negative CSF makes a diagnosis of MS highly unlikely.…”

Section: Tier I Tests May Help Determine Ms Risksupporting

confidence: 73%

Optimizing Outcomes in Multiple Sclerosis – A Consensus Initiative

et al. 2009

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Background Initiation of immunomodulators in patients experiencing a clinically isolated syndrome (CIS) may delay progression to clinically definite MS. However, lack of consensus remains on many issues affecting optimal management of MS. Method A panel of 21 MS experts met during 9 meetings to explore key issues in MS and CIS. Meetings addressed 3 phases: 1. CIS definition and diagnosis; 2. initial therapy; and 3. monitoring disease progression and treatment efficacy. Newsletters covering each phase were sent to 5000 U.S.-based neurologists who were invited to participate in an online survey on key issues. Results Most panel members agreed that early treatment may minimize neurodegeneration and most would recommend it for patients; that a dose-response relationship exists for beta-interferon therapy; that more aggressive therapy was most effective early in the disease course; and, that MRI has a role in monitoring disease progression. In face of suboptimal response, most would switch patients to a different therapy; while combination therapy would be reserved for those failing monotherapy regimes. Most online survey respondents agreed with these positions. Conclusions There was uniform consensus from this panel of MS experts that early initiation of immunomodulator therapy was beneficial for CIS patients.

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“…These determinations are supported by the literature [14,15]. The group concluded that optic neuritis with a normal brain MRI and negative CSF makes a diagnosis of MS highly unlikely.…”

Section: Tier I Tests May Help Determine Ms Risksupporting

confidence: 73%

Optimizing Outcomes in Multiple Sclerosis – A Consensus Initiative

et al. 2009

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“…Any atypical presentations should prompt one to investigate further to exclude secondary causes of visual failure. 24,25,26 Indian's experience with optic neuritis is not very wide, but is consistent with the studies elsewhere. 27 In a long-term followup of recurrent ON, Pirko et al observed that 12.5% patients developed Neuromyelitis Optica (NMO) and another 14.4% developed MS.…”

Section: Discussionsupporting

confidence: 86%

Isolated Visual Loss and Neurological Causes: A Hospital-Based Study

G¹,

Reddy²,

R³

et al. 2016

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Visual loss is a common presenting symptom in the Outpatient Departments of Neurology, Ophthalmology and General Medicine disciplines. The present prospective study aims at evaluating 48 patients with partial or total visual loss as the predominant or only presenting symptom and with no associated ocular problems like cataract, glaucoma or diabetic retinopathy. The neurological causes were identified, analysed and tabulated; 39% of patients were below 20 years of age and there was 3:2 ratio of female versus male prevalence. Nearly 66% had acute visual loss and 35% had chronic visual loss. Majority of patients (48%) had profound visual loss limited to finger counting; 6% had normal visual acuity associated with field defects. The visual evoked potentials were abnormal in all cases with acute and sub-acute presentation and in some patients with sudden or chronic presentation also. The VEP abnormalities consisted of prolonged P100 latencies, loss of amplitudes or poor wave morphology. Cranial CT scan was done in 36 patients and was abnormal in 83% patients. It showed intracranial tumours in 8% patients and infarcts in another 8% patients. Cranial MRI scan was done in 12 patients and was normal in 83% patients. The aetiological considerations and treatment protocols followed are discussed. The limitations of such study in the present setup are also highlighted.

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“…Intracranial lesions may present with acute optic neuropathy mimicking optic neuritis. For example, a case series of 8 patients with atypical optic neuritis reported 2 tuberculum sellae meningiomas [13]. Features such as a progressive course, absence of pain, and optic atrophy at presentation warrant neuroimaging.…”

Section: Discussionmentioning

confidence: 99%