Incidence and Mimickers of Acute Idiopathic Optic Neuritis: Analysis of 291 Consecutive Patients from Southern Finland

Siuko, Mika; Kivelä, Tero; Setälä, Kai; Tienari, Pentti J.

doi:10.1080/09286586.2018.1500614

Cited by 6 publications

(3 citation statements)

References 34 publications

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“…During the study period, 291 patients with a condition suggestive of ON were examined; 184 (63%) were diagnosed with ON and 107 (37%) with another condition. These other conditions have been reported previously (Siuko et al, 2018).…”

Section: Study Populationsupporting

confidence: 81%

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The clinical spectrum and prognosis of idiopathic acute optic neuritis: A longitudinal study in Southern Finland

Siuko

Kivelä

Setälä

et al. 2019

Multiple Sclerosis and Related Disorders

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Background: To analyse in a population-based setting the clinical features, prognostic factors, and seasonality of patients diagnosed with acute idiopathic optic neuritis (ON). Methods: Retrospective analysis of ophthalmological records, laboratory parameters, and magnetic resonance imaging (MRI) of patients with symptoms suggestive of ON referred to the Helsinki University Hospital (serving a population of 1.53 million in Southern Finland) were analysed between May 1, 2008 and April 14, 2012. Results: Of the 291 patients with suspected ON, 184 (63%) were diagnosed with ON (mean age 34 years, 76% females). Intravenous methylprednisolone treatment was administered in 131 (71%) patients. First ON was diagnosed in 123 patients (67%), 55 (30%) had a previous diagnosis of multiple sclerosis (MS) and two patients with their first ON were diagnosed with neuromyelitis optica. Evolution of best corrected visual acuity (BCVA) was analysed in 132 (72%) patients, who were reviewed median of 38 days after onset. Median and mean BCVAs in these reviewed patients were 0.4 and 0.2 at the time of diagnosis and 1.0 and 0.5 at the time of the review. Recovery was relatively good in the majority of patients; 82% (n = 108) had reached BCVA of ≥0.5 and 70% (n = 92) and BCVA of ≥0.8 at the time of the review, while thirteen (10%) had poor prognosis, BCVA ≤0.1 at review. Accessory clinical features included optic disc swelling (21%), colour vision impairment (75%), and pain with eye movements (65%). Relative afferent pupillary defect was abnormal in 76% of the patients with their first ON. Baseline visual acuity was most strongly associated with visual outcome at review (P < 0.001, linear regression). Optic disc swelling and the presence of lesions in the optic nerve on MRI had a more modest association with poorer recovery (P = 0.033 and P = 0.049, respectively), while age, sex, previous history of ON, and previous diagnosis of multiple sclerosis were not associated with outcome at review. Incidence of ON showed a clear seasonal pattern; there were two times more cases in April to June versus October to December (P = 0.03), confirming previous results from Sweden. Conclusions: Our data suggest that besides baseline visual acuity, optic disc swelling and lesions in the optic nerve on MRI are associated with poorer prognosis. As in previous studies, we observed that diagnostics of ON is difficult, accessory clinical findings such as pain and RAPD are not always present. Although the diagnosis of ON is clinical, the role of MRI should be considered in differential diagnostics and in defining potential prognostic markers.

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Section: Study Populationsupporting

confidence: 81%

“…The diagnosis of ON is essentially clinical; no universal diagnostic criteria are available (Hickman et al, 2002). It has become increasingly evident that a substantial portion of patients with suspected ON do not have genuine ON (Siuko et al, 2018, Stunkel et al, 2018. Accordingly, efforts should be made to improve diagnostic accuracy.…”

Section: Introductionmentioning

confidence: 99%

The clinical spectrum and prognosis of idiopathic acute optic neuritis: A longitudinal study in Southern Finland

Siuko

Kivelä

Setälä

et al. 2019

Multiple Sclerosis and Related Disorders

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show abstract

“…25 The differential diagnosis of ON is broad, and recently published diagnostic criteria for ON 24 aid in its differentiation from optic neuropathies; other ocular disorders such as retinal, uveal and scleral disease; functional visual loss; and primary headache disorders with peri-ocular pain and/or visual symptoms. 24,26 Many disorders frequently mistaken for ON do not involve the optic nerve, 10,26 and key clinical findings supportive of an optic nerve lesion include unilateral central scotoma with abnormal visual acuity, relative afferent pupillary defect, and impaired color vision (Figure 1). 24 The absence of these findings and the presence of other clinical "red flags" suggest an alternative localization (Table 1).…”

Section: Clinical Considerationsmentioning

confidence: 99%

Differential diagnosis of suspected multiple sclerosis: an updated consensus approach

Solomon

Arrambide

Brownlee

et al. 2023

The Lancet Neurology

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Applying the 2022 optic neuritis criteria to noninflammatory optic neuropathies with optic nerve T2-hyperintensity: an observational study

Labella Álvarez,

Biousse,

Mosleh

et al. 2024

J Neurol

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Incidence and Mimickers of Acute Idiopathic Optic Neuritis: Analysis of 291 Consecutive Patients from Southern Finland

Abstract: More than a third of patients with symptoms suggestive of ON had another condition. Demyelinative lesions on MRI indicated higher risk of developing MS. We recommend the use of MRI to improve the differential diagnostic accuracy of ON and to identify patients with high risk of MS.

Cited by 6 publications

References 34 publications

The clinical spectrum and prognosis of idiopathic acute optic neuritis: A longitudinal study in Southern Finland

The clinical spectrum and prognosis of idiopathic acute optic neuritis: A longitudinal study in Southern Finland

Differential diagnosis of suspected multiple sclerosis: an updated consensus approach

Applying the 2022 optic neuritis criteria to noninflammatory optic neuropathies with optic nerve T2-hyperintensity: an observational study

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