Diagnosis Approach of Optic Neuritis

Abstract

The approach of the etiology of an optic neuropathy can be difficult for both ophthalmologists and neurologists, because neither the appearance of the optic disc, the perimetry, or the findings in Optical Coherence Tomography (OCT) or Magnetic Resonance Imaging (MRI) are specific. Clinical features common to optic neuropathies are vision loss, visual fields scotomas and dyschromatopsia. Pain is a variable feature that, when is present, suggest an inflammatory disorder. Relative afferent pupilary defect is a required clinical finding for the diagnosis of unilateral optic neuropathy. The term "Typical optic neuritis" (ON) has been widely used to design a unilateral ON that presents in a young patient with an acute or subacute presentation, with pain worsened with eye movements and generally good prognosis. In this scenario, idiopathic or Multiple Sclerosis (MS) are the most likely etiologies. Therefore, in these cases, brain MRI with gadolinium contrast should be performed in order to establish the risk of conversion to MS. OCT is a useful test to evidence the retinal nerve fiber layer and ganglion cell-inner plexiform layer changes. Any modification of the mentioned clinical pattern should be consider "atypical" and further investigation is necessary in order to discard other possibilities such as ischemic, autoimmune, compressive-infiltrative, hereditary, toxic, nutritional deficiency, posttraumatic, postradiotherapy or intracraneal hypertension. Therefore, we must follow a rational algorism from the most common cause to the most unlikely in each case, with a well-defined previous distinction of the typical and atypical features, because both the early diagnosis and treatment are overriding in the second ones.

Evaluation of Retinal Structure and Optic Nerve Function Changes in Multiple Sclerosis: Longitudinal Study with 1-Year Follow-Up

“…Compared with healthy individuals, MS patients have a significantly higher rate of optic atrophy. In certain cases, optic atrophy may result from a previous severe inflammation that occurs diffusely or temporally [39].…”

“…e optic disc is the entry point of the optic nerve which is composed of numerous axons. In MS, axonal degeneration is responsible for the development of optic atrophy observed during funduscopy [39].…”

Karakteristik Pasien Optic Neuritis Di Rumah Sakit Umum Pusat (Rsup) Sanglah Periode 1 Januari-31 Desember 2018

“…Saraf optik dibentuk oleh satu juta akson yang berasal dari sel ganglion retina dan merupakan perpanjangan dari sistem saraf pusat (SSP). Atau lebih mudah bila didefinisikan sebagai saluran yang memanjang dari mata ke kiasma optik 1 . Optic neuritis (ON) adalah peradangan yang terjadi pada saraf optik, akibatnya terjadi dimielinnasi karena peradangan saraf.…”

“…ON atipikal sendiri memang lebih sering dialami oleh populasi orang Afrika, Asia, dan keturunan Polynesia. 1,7,14 Pengobatan pasien ON yang disarankan berdasarkan ONTT adalah injeksi metilprednisolon 250 mg setiap 6 jam selama 3 hari dan dilanjutkan dengan prednisone oral 1 mg/hari selama 11 hari. 12 Pada penelitian ini lebih dari sebagian pasien diobati dengan metode ini.…”

Influence of clinical history on MRI interpretation of optic neuropathy

“…Abnormal contrast enhancement is seen in active inflammatory or demyelinating lesions as a result of breakdown of the blood-nerve barrier [ 1 , 7 ]. Segmental atrophy of the nerve in chronic lesions is the result of axonal loss [9] .…”