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13 results

  • Myelin Oligodendrocyte Glycoprotein Antibody-Associated Optic Neuritis in Canada

  • Anubhav Garg, Edward Margolin, Jonathan A. Micieli
  • Journal:
    Canadian Journal of Neurological Sciences / Volume 48 / Issue 3 / May 2021
    Published online by Cambridge University Press:
    14 September 2020, pp. 321-326
    • Article
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  • Objective:

    To describe clinical characteristics of Canadian patients with myelin-oligodendrocyte glycoprotein immunoglobulin-G optic neuritis (MOG-IgG ON).

    Methods:

    Retrospective observational case series of MOG-IgG seropositive patients with ON referred to tertiary neuro-ophthalmology practices. Outcome measures included clinical characteristics, radiologic findings, and visual outcomes.

    Results:

    Forty-six eyes of 30 patients were included. Twenty-three (76.7%) were women, mean onset age was 40.7 years (range 16–77), and most were Caucasian. Seventeen (56.7%) presented with their first ON episode. Sixteen (53.3%) had bilateral eye involvement. Isolated ON without associated neurological symptoms occurred in 90.0%. In 22 patients with acute ON (seen within 1 month of onset), presenting mean visual acuity (VA) was 20/258 (logMAR 1.11), mean deviation (MD) on Humphrey visual fields was −16.90 ± 10.83 dB, and peripapillary retinal nerve fiber layer (RNFL) thickness on ocular coherence tomography (OCT) was 164.23 ± 46.53 um. Orbital magnetic resonance imaging (MRI) within 1 month of symptom onset for 19 patients demonstrated orbital optic nerve enhancement in 11 (57.9%) and perineural enhancement in 11 (57.9%). Brain MRI was normal in 28 (93.3%) patients. Twenty out of 22 patients with acute presentation were treated with high-dose glucocorticoids and 5 with plasma exchange in addition to corticosteroids. Long-term immunosuppression was utilized in 9 (30%) out of all 30 patients. Final VA was 20/30 (logMAR 0.18), MD was −7.17 ± 8.85 dB, and RNFL thickness was 72.15 ± 20.16 um.

    Conclusion:

    MOG-IgG ON in Canada has a variable presentation with most patients having substantial initial vision loss with good recovery. This is the largest characterization of the disease in Canada to date.

  • Optic Neuritis in Guillain-Barre Syndrome

  • Anita M. Dayal, Kurt Kimpinski, J. Alexander Fraser
  • Journal:
    Canadian Journal of Neurological Sciences / Volume 44 / Issue 4 / July 2017
    Published online by Cambridge University Press:
    01 February 2017, pp. 449-451
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  • Visual loss following head and neck surgery

  • A J B Crockett, A Trinidade, P Kothari, J Barnes
  • Journal:
    The Journal of Laryngology & Otology / Volume 126 / Issue 4 / April 2012
    Published online by Cambridge University Press:
    18 October 2011, pp. 418-420
    Print publication:
    April 2012
  • Introduction:

    Non-arteritic ischaemic optic neuritis is a known post-operative complication of ophthalmological and maxillofacial surgery, but has not been widely described as a potential consequence of head and neck surgery.

    Aim:

    To highlight non-arteritic ischaemic optic neuritis as a potential risk in patients undergoing head and neck surgery.

    Subject and method:

    Case report of a 60-year-old man undergoing total laryngectomy and bilateral neck dissection for laryngeal squamous cell carcinoma.

    Result:

    On day 14 post-operatively, the patient suffered substantial oral bleeding secondary to an internal jugulo-neopharyngeal fistula. Following emergency haemostatic measures, the patient was immediately aware of visual disturbances. The ophthalmologists concluded that these were due to non-arteritic ischaemic optic neuritis, caused by acute hypoxaemia secondary to substantial blood loss.

    Conclusion:

    The prognosis of non-arteritic ischaemic optic neuritis is poor. Thus, it is crucial that otolaryngologists are aware of this complication of head and neck surgery, as immediate diagnosis and treatment can help prevent worsening visual loss.

  • Chapter 9 - Corticosteroids in pediatric multiple sclerosis relapses

  • from Section 2 - Pediatric MS Course and Treatment
  • Edited by Dorothée Chabas, University of California, San Francisco, Emmanuelle L. Waubant, University of California, San Francisco
  • Book:
    Demyelinating Disorders of the Central Nervous System in Childhood
    Published online:
    11 April 2011
    Print publication:
    17 March 2011, pp 92-95

  • Summary

    This chapter discusses how current operational definitions can apply to clinical practice and research settings of pediatric multiple sclerosis (MS) and acute disseminated encephalomyelitis (ADEM). It emphasizes strengths and limitations of these clinical practice and research settings. ADEM requires the presence of both encephalopathy and polysymptomatic presentation. Three major controversies concerning the criteria of dissemination in time relate to the fact that a consensus has not been reached about when to call pediatric MS a recurrent disease in: patients with a first ADEM-like episode who further develop non- ADEM-like episodes, patients with recurrent ADEM including more than two episodes, and patients with recurrent non-ADEM-like events such as optic neuritis (ON) or transverse myelitis (TM) without brain MRI findings and without neuromyelitis optica (NMO) IgG. The first two situations are fairly specific of the pediatric population, given the higher frequency of ADEM or ADEM-like presentations in children, especially before puberty.

  • Chapter 18 - MRI features of acute disseminated encephalomyelitis

  • from Section 4 - ADEM
  • Edited by Dorothée Chabas, University of California, San Francisco, Emmanuelle L. Waubant, University of California, San Francisco
  • Book:
    Demyelinating Disorders of the Central Nervous System in Childhood
    Published online:
    11 April 2011
    Print publication:
    17 March 2011, pp 202-211

  • Summary

    This chapter reviews the use of corticosteroids for acute relapses in pediatric multiple sclerosis (MS). Corticosteroids are used to treat inflammatory conditions as they modulate the immune system through multiple mechanisms. Corticosteroids are considered type A drugs for treating MS relapses in adults. In patients with optic neuritis (ON), high-dose intravenous methylprednisolone (IVMP) 1 g/day for 3 days has been shown to be effective at hastening recovery. Another study showed that patients receiving IVMP within 8 weeks of an acute relapse had lower mean Expanded Disability Scale Scores (EDSS) assessed at 1 and 4 weeks compared to placebo. Most adult studies suggest that high-dose IVMP should be dosed at 500-1000 mg daily for 3-5 days. Long-term use of corticosteroids is associated with numerous and substantial adverse effects. The side effects of prolonged exposure to corticosteroids include osteoporosis, neutropenia, weight gain, adrenal suppression, acne, increased skin fragility, hypertension, and psychosis.

  • 22 - Ocular Ultrasound

  • from PART II - ULTRASOUND
  • Edited by J. Christian Fox, University of California, Irvine
  • Book:
    Clinical Emergency Radiology
    Published online:
    07 December 2009
    Print publication:
    29 September 2008, pp 325-329

  • Summary

    Ultrasound has long been an integral part of the ophthalmologist's examination of the eye and orbit. The use of ocular ultrasound was first published in 1956 and has since come to be used extensively with A-scan, B-scan, Doppler, and, more recently, 3D approaches. Both axial and longitudinal approaches are commonly employed in ED ultrasound of the eye and orbit. Due to the emphasis on recognition of acute life-threatening conditions in the ED, the application of ocular ultrasound most widely studied in the emergency medicine literature is in the evaluation of increased intracranial pressure by evaluation of optic nerve sheath diameter. Ultrasound easily allows identification of lens dislocation, vitreous hemorrhage, and globe rupture, among other traumatic conditions. ED ultrasound may also prove to be useful in the evaluation of optic neuritis. Ocular ultrasound is a relatively new ED imaging modality that is rapidly gaining acceptance among emergency clinicians.

  • Chromatic discrimination losses in multiple sclerosis patients with and without optic neuritis using the Cambridge Colour Test

  • ANA LAURA DE ARAÚJO MOURA, ROSANI APARECIDA ANTUNES TEIXEIRA, NESTOR N. OIWA, MARCELO F. COSTA, CLAUDIA FEITOSA-SANTANA, DAGOBERTO CALLEGARO, RUSSELL D. HAMER, DORA FIX VENTURA
  • Journal:
    Visual Neuroscience / Volume 25 / Issue 3 / May 2008
    Published online by Cambridge University Press:
    03 July 2008, pp. 463-468

  • We assessed chromatic discrimination in multiple sclerosis (MS) patients both with (ON) and without (no ON) a history of optic neuritis using the Cambridge color test (CCT). Our goal was to determine the magnitude and chromatic axes of any color vision losses in both patient groups, and to evaluate age-related changes in chromatic discrimination in both patient groups compared to normals. Using the CCT, we measured chromatic discrimination along the protan, deutan and tritan axes in 35 patients with MS (17 ON eyes) and 74 age matched controls. Color thresholds for both patient groups were significantly higher than controls' along the protan and tritan axes (p < 0.001). In addition, the ON and no-ON groups differed significantly along all three-color axes (p < 0.001). MS patients presented a progressive color discrimination impairment with age (along the deutan and tritan axes) that was almost two times faster than controls, even in the absence of ON. These findings suggest that demyelinating diseases reduce sensitivity to color vision in both red-green and blue-yellow axes, implying impairment in both parvocellular and koniocellular visual pathways. The CCT is a useful tool to help characterize vision losses in MS, and the relationship between these losses and degree of optic nerve involvement.

  • 19 - Multiple Sclerosis

  • from SECTION III - SPECIFIC NEUROLOGICAL CONDITIONS
    • By Thomas F. Scott, Department of Neurology Allegheny General Hospital Pittsburgh, Pennsylvania
  • Edited by Sid M. Shah, Michigan State University, Kevin M. Kelly, Drexel University, Philadelphia
  • Book:
    Principles and Practice of Emergency Neurology
    Published online:
    06 August 2009
    Print publication:
    18 February 2003, pp 210-217

  • Summary

    The primary pathological event in multiple sclerosis (MS) lesion development is an immune-mediated destruction of the neuronal myelin sheath. The inflammatory lesions of MS can affect any part of the central nervous system and optic nerves, resulting in a wide variety of presenting symptoms. The first symptoms of MS are commonly weakness, paresthesias, visual loss, incoordination, vertigo, and sphincter impairment. Focused testing of cranial nerve function, strength, coordination, gait, and sensation, and an evaluation for pathological reflexes are important. The onset of MS is heralded by a bout of optic neuritis in about 20% of patients with MS, and more than 50% of patients with optic neuritis eventually develop the disease. Neuroimaging assists in differentiating MS from mass lesions, infections, or strokes. Patients with relapsing-remitting multiple sclerosis (RRMS) who experience an acute exacerbation of their illness present with either recurrence or worsening of old symptoms, or entirely new neurological symptoms.

  • Malignant otitis externa with optic neuritis

  • A. P. Bath, J. R. Rowe, A. J. Innes
  • Journal:
    The Journal of Laryngology & Otology / Volume 112 / Issue 3 / March 1998
    Published online by Cambridge University Press:
    29 June 2007, pp. 274-277
    Print publication:
    March 1998

  • Malignant otitis externa is a serious condition that presents difficulties in treatment, and also in monitoring its progress. A case of malignant otitis externa with optic neuritis is presented that remained refractory to standard treatment but was cured by adjuvant hyperbaric oxygen therapy. This is the only reported case that has survived this disease with optic neuritis. The usefulness of imaging techniques in this condition is discussed, as well as the ESR, in evaluating the effectiveness of treatment.