Inflammatory Optic Neuritis: From Multiple Sclerosis to Neuromyelitis Optica

Abstract

Inflammatory optic neuritis represents a frequent clinical situation in neurology and ophthalmology. In those parts of the world where multiple sclerosis is common, it is the condition most discussed as the cause of optic neuritis. However, the risk for conversion from optic neuritis to multiple sclerosis is evaluated at only around 50% after 15 years of follow-up. The risk is higher in cases in whom abnormalities typical of multiple sclerosis are found on magnetic resonance imaging of the brain and oligoclonal bands found on cerebrospinal fluid protein electrophoresis with no corresponding bands in serum. When these investigations are normal, optic neuritis is usually considered as ''idiopathic'' with a suspected viral aetiology, but in some cases, a systemic disease such as sarcoidosis, systemic lupus erythematosis, or Sjö gren syndrome may be diagnosed. In rare cases, either recurrent optic neuritis or myelitis may occur without any evidence for multiple sclerosis. In the first case, it corresponds to a recently characterised disorder referred to as chronic relapsing inflammatory optic neuropathy and in the second case to a recently better identified entity, neuromyelitis optica. In the present paper, the differential diagnosis of inflammatory optic neuritis is presented from multiple sclerosis to infectious optic neuritis, systemic disease, and neuromyelitis optica.

Chronic relapsing inflammatory optic neuropathy

“…The detection of these individuals is important for pa-tient management targeted at the preservation of vision because there is a considerable risk of blindness. [4] The present patient had experienced recurrent episodes of optic neuropathy over a period of 5 years with features that led to a diagnosis of CRION.…”

“…[3,5] These were important for patient management targeted at the preservation of vision because in contrast to MS, there is a considerable risk of blindness with CRION. [4] Immunosuppressive treatment may allow for the discontinuation of steroid use and prevent or reduce further relapses in cases of CRION, which is dissimilar from MS in its clinical characteristics and natural history. [4] In view of these recurrent steroid-responsive attacks of ON, a differential diagnosis for other demyelinating disorders, such as MS or an NMO spectrum disorder, as well as other causes of secondary demyelination, must be thoroughly considered.…”

Neuromyelitis optica spectrum disorder: an overview

“…Immunosuppressive drugs such as azathioprine, mycophenolic acid, methotrexate, mitoxantrone, rituximab, eculizumab etc. are administered for preventing future attacks (Jacob et al, 20092013;Costanzi et al, 2011;Pittock et al, 2013;Kitley et al, 2013). Despite all these available options, NMOSD remains incurable.…”

Visual Loss in Neuro-Ophthalmology

“…This may occur in meningitis/encephalitis [34] and is treatable. The pathogens could be bacteria (Homophiles, Streptococcus, Staphylococcus, spirochetes, or mycobacteria), protozoa as Toxoplasmosis, fungi as Cryptococcus or Aspergillus, or herpes viruses [35,36]. Syphilitic optic neuritis can develop very rapidly from every stage of the disease.…”