Optic nerve cysticercosis

Cysticercosis of the optic nerve is an extremely rare entity and only seven cases have been reported in the world literature. A case of optic nerve cysticercosis in a 25-year-old woman is reported, along with a review of literature. The patient presented with two episodes of pain, diminution of vision and proptosis. Computed tomography and ultrasonography revealed an intraneural cyst with scolex in the retrobulbar portion of the optic nerve. A positive enzyme-linked immunosorbent assay test for cysticercosis further confirmed the diagnosis. Medical therapy in the form of oral albendazole and steroids resulted in complete resolution of the cyst, with few visual sequelae.     

Optic neuritis

Aims

The aim of this study is to provide a clinical update on optic neuritis (ON), its association with multiple sclerosis (MS), and neuromyelitis optica (NMO).

Methods

This study included a PubMed review of the literature written in the English language.

Results

ON in adults is typically idiopathic or demyelinating, and is characterised by unilateral, subacute, painful loss of vision that is not associated with any systemic or other neurological symptoms. Demyelinating ON is associated with MS, and we review the key studies of ON including the ON treatment trial and several other MS treatment trials and NMO.

Conclusion

Acute demyelinating ON can occur in isolation or be associated with MS. Typical ON does not require additional evaluation other than cranial magnetic resonance imaging. NMO is likely a separate disorder from MS and the ON in NMO has a different treatment and prognosis.

Methodology

The authors conducted an English language search using Pubmed from the years 1964 to 2010 using the search terms ‘ON'', ‘MS'' and ‘NMO''. The authors included original articles, review articles, and case reports, which revealed new aspects as far as epidemiology, histopathology, clinical manifestations, imaging, genetics, and treatment of ON. Titles were reviewed for topicality and full references were obtained. Letters to the editor, unpublished work, and abstracts were not included in this review.     

视神经炎与细胞因子

视神经炎(opticneuritis,ON)是一组由病毒感染引起的,以视神经纤维脱髓鞘为特征的自身免疫性疾病。视神经炎与多发硬化关系密切。本文就影响视神经炎发展成为多发硬化的因素及细胞因子在多发硬化中所起的作用,综述如下。     

表现为眼眶(炎性)假瘤的视神经束膜炎(英文)

目的:报道1例罕见的临床上表现为眼眶炎性假瘤形式的视神经束膜炎,并且强调区分视神经束膜炎和脱髓鞘的球后视神经炎。方法:病例报道。结果:一个54岁的健康的马来西亚女性,主诉右侧持续性头痛3d伴有复视。疼痛与眼球活动相关联。脑部和眼眶MRI显示右侧视神经鞘和眶内脂肪条纹异常增强,未有异常的增强提示脱髓鞘疾病。这名患者诊断为右眼视神经束膜炎。从开始使用全身性的类固醇激素,维持并逐渐减量超过6mo。她的症状得到缓解并且直到最近的随访都没有复发。结论:所有的眼眶炎性假瘤病例都应该考虑存在视神经束膜炎的可能,在开始治疗前必须与球后视神经炎相鉴别。因为这两种疾病有不同的治疗原则和预后。     

视神经炎的疾病分类学研究进展

视神经炎指发生于视神经的一切炎性病变,是神经眼科最常见的视神经疾病之一,也是中青年人最易罹患的视神经疾病.目前,国内外对视神经炎的分类方法主要有两种,一种按发病部位分类,可分为球后视神经炎、视乳头炎、视神经周围炎和视神经视网膜炎;另一种根据病因学分类,可分为中枢神经系统炎性脱髓鞘性疾病相关视神经炎、感染性疾病相关性视神经炎及全身系统性自身免疫性疾病相关性视神经炎.目前,我国的视神经炎病因学特点尚有待进一步开展大样本的流行病学研究.     

Choroidal changes in eyes treated with high-dose systemic corticosteroids for optic neuritis

AIM: To analyze the effect of systemic high-dose corticosteroid on the choroid in patients with unilateral optic neuritis. METHODS: A retrospective comparative cohort study. Seventy-six eyes of 38 patients with unilateral optic neuritis that received systemic high-dose corticosteroid treatment were enrolled. Choroidal thickness (CT) and choroidal vascularity index (CVI) were measured in both affected and the fellow eyes at baseline, 1wk, 1 and 3mo. Changes in CT and CVI were analyzed in both eyes and compared between eyes. RESULTS: The mean CT and CVI were 349 μm and 0.70 in the affected eyes and 340 μm and 0.69 in the fellow eyes at baseline (P=0.503 and 0.440, respectively). Decrement of CT and CVI at month 3 were significant in affected eyes (P=0.017 and P<0.001). Decreased CVI began 2wk after treatment whereas CT decreased from 1mo. The CVI also decreased significantly in fellow eyes at 3mo compared to the baseline (P=0.001). CONCLUSION: A significant decrement in CT and CVI can appear after 3mo in optic neuritis patients treated with high-dose systemic corticosteroid treatment. The decrease in CVI appeared earlier than the decrease in CT, suggesting choroidal vasoconstriction caused by systemic steroid as a possible mechanism.     

Optic neuritis in children with poor recovery of vision

We reviewed the records of 10 children with optic neuritis in whom recovery of vision was poor or incomplete. Our cases were otherwise similar to those described in previous studies in that they were always bilateral, often accompanied by a viral prodrome (seven of 10), and usually associated with disc oedema (seven of 10).
Seven of twenty eyes had a final visual acuity of 6/60 or worse and only one patient regained 6/6 vision in either eye. In three patients the best vision in either eye was 6/60 or worse. Recovery of vision was often slow, taking up to six years. Five of 10 patients have developed multiple sclerosis (MS), and one child had acute disseminated encephalomyelitis (ADEM) with optic neuritis.
Optic neuritis in children does not always carry a good prognosis for recovery of vision; however, the failure of vision recovery in a short period of time does not necessarily indicate a poor outcome. Some children with optic neuritis develop MS, which can develop even when optic neuritis follows a viral illness.     

Optic neuritis in evolution

A case of progressive optic neuropathy in a woman with a history of breast cancer is presented. Differential diagnoses including optic neuritis, infiltrative optic neuropathy, carcinomatous meningitis, and toxic optic neuropathies are discussed. Risk factors for metastatic brain lesions are also discussed.     

Optic nerve functions and visual evoked potential after acute optic neuritis

目的:比较视神经炎患者和正常人的视神经功能与视觉诱发电位.方法:本研究为2011年9月至2013年2月在马来西亚大学眼科医院进行的横断面研究.研究包含在检查前3mo至2y间发生特发性神经炎一次的视神经炎患者20例和10例正常人.眼科检查包括视力、色觉、视觉灵敏度、视野和视觉诱发电位.独立t检验用于比较视神经炎组与对照组视神经功能和VEP参数的差异.在参数非正态分布时,Mann-Whitney试验用于比较两组间的中位数.结果:视神经炎组的平均年龄为30.8岁.在视神经炎发作至评估期间的平均持续时间为6.6个月.视神经炎组视力较差,平均LogMAR值(0.52)明显高于对照组(P=0.001).色觉下降,视神经炎组的平均值为63%(P=0.001).视神经炎患者的对比敏感度在四个空间频率上均有所下降 [3CPD(P=0.029),6CPD(P=0.026),12CPD(P=0.002)、18CPD(P=0.006)].视神经炎组的视野下降有统计学意义(P<0.001).与对照组相比,视神经炎组的VEP P100潜伏期有轻微延长.但使用棋盘格模式1或2时,VEP潜伏期的差异不显著.视神经炎患者的VEP振幅较高,但两组差异无统计学意义.结论:视神经炎急性发作,平均6mo后视神经功能(即视力、色觉、对比敏感度和视野)显著下降.视神经炎组和对照组的VEP振幅和潜伏期无显著差异.VEP可能不是理想的诊断视神经炎既往发作史的试验,尽管VEP参数在浮动后趋于正常.     

Optic Nerve Cysticercosis: Case Report and Review of Current Management

The authors present a case of optic nerve cysticercosis in a 32-year-old patient who presented with sudden blurring of vision in the left eye and a transient visual improvement on systemic steroids. The ocular findings were unremarkable other than a relative afferent pupillary defect (RAPD). An ultrasound of the orbit, CT and MRI scans revealed a cystic lesion in the orbital portion of the optic nerve close to the eyeball. A presumed diagnosis of optic nerve cysticercosis was made on the basis of imaging and a positive serum ELISA. The patient improved dramatically on a 4-week therapeutic trial of albendazole and oral steroids. The post-treatment ultrasound and CT scan showed an involution of the cyst with some residual thickening of the optic nerve.     

Optic neuritis is nothing to sneeze at

A 36-year-old man developed acute visual loss, mimicking an optic neuritis in the left eye. Cranial magnetic resonance imaging revealed a sphenoid sinus mucocele with extension into the anterior clinoid process abutting the left optic nerve. Endoscopic marsupialization of the mucocele led to marked improvement of vision. Sphenoid sinus mucocele is discussed, as is the differential diagnosis of optic neuritis.     

Optic neuritis with multiple sclerosis in a 10-year-old Asian girl

AIM: To report a case of unilateral optic neuritis with multiple sclerosis(MS) in an Asian child. · METHODS: A case report. · RESULTS: A 10-year-old Chinese girl presented with history of sudden loss of vision of the right eye for 3 days. It was associated with pain in eye movement. She gave history of fever associated with ataxic gait a year ago. She had been diagnosed with acute disseminated encephalomyelitis (ADEM). Visual acuity in the right eye was 'counting finger' with positive afferent pupillary defect. The optic disc was swollen and hyperemic. The colour vision was severely impaired. Visual field showed central scotoma and enlarged blind spot. Magnetic resonance imaging (MRI) of the brain revealed multiple intense lesions in the left occipital lobe, basal ganglia and periventricular regions suggesting MS. She was treated with intravenous methylprednisolone for 3 days, followed by oral prednisolone for 11 days. She had excellent recovery and her visual acuity improved to 6/9. She remained asymptomatic for 3 years. · CONCLUSION: The simultaneous occurrence of optic neuritis and MS is less common in children and seldom reported. We presented this case to highlight the possibility of this disease occurring in Asian population in a younger age group.     

亚洲女童视网膜炎合并多发性硬化1例

目的:报道亚洲儿童单侧视神经炎合并多发性硬化1例方法:病例报道结果:中国女孩10岁,右眼视力突然持续下降3d,伴有眼球运动痛。患者1a前曾有高热并伴有步态共济失调病史。当时被诊断为急性弥散性脑脊髓炎,右眼视力数指,伴有瞳孔传入阻滞,视盘充血水肿,色觉功能受损严重。视野检查显示中心暗点及盲点扩大。脑部磁共振MRI结果显示大脑左侧枕叶有较高密度影损害,神经中枢基部和脑室周围的区域提示多发性硬化。给予患者甲基强的松龙静脉滴注3d,以后改为口服强的松龙11d。患者出现明显好转,视力提高到6/9,并且维持3a没有复发结论:视神经炎合并多发性硬化在儿童中比较罕见且鲜有报道。我们报道这个病例就是为了强调这个疾病在亚洲青少年人群出现的可能性。     

Optic neuritis with multiple sclerosis in a 10-yearold Asian girl

AIM: To report a case of unilateral optic neuritis with multiple sclerosis in an Asian child. METHODS: A case report. RESULTS: A 10-year-old Chinese girl presented with history of sudden loss of vision of the right eye for 3 days’ duration. It was associated with pain in eye movement. She gave history of fever associated with ataxic gait a year ago. She had been diagnosed to have acute disseminated encephalomyelitis (ADEM). Visual acuity in the right eye was 'counting finger' with positive afferent pupillary defect. The optic disc was swollen and hyperemic. The colour vision was severely impaired. Visual field showed central scotoma and enlarged blind spot. Magnetic resonance imaging (MRI) of the brain revealed multiple intense lesions in the left occipital lobe, basal ganglia and periventricular regions suggesting multiple sclerosis. She was treated with intravenous methylprednisolone for 3 days, followed by oral prednisolone for 11 days. She had excellent recovery and her visual acuity improved to 6/9. She remained asymptomatic for 3 years. CONCLUSION: The simultaneous occurrence of optic neuritis and multiple sclerosis is less common in children and seldom reported. We presented this case to highlight the possibility of this disease occurring in Asian population in a younger age group.     

Treatment options for atypical optic neuritis

Context:Optic neuritis (ON) is defined as inflammation of the optic nerve and can have various etiologies. The most common presentation in the US is demyelinating, or “typical” ON, usually associated with multiple sclerosis. This is in contrast to “atypical” causes of ON, which differ in their clinical presentation, management, and prognosis. These atypical cases are characterized by lack of eye pain, exudates, and hemorrhages on exam, very severe, bilateral or progressive visual loss, or with failure to recover vision.Aims:The aim was to describe the clinical presentations of atypical ON and their treatments.Results:Types of atypical ON identified include neuromyelitis optica, autoimmune optic neuropathy, chronic relapsing inflammatory optic neuropathy, idiopathic recurrent neuroretinitis, and optic neuropathy associated with systemic diseases. Atypical ON usually requires corticosteroid treatment and often will require aggressive immunosuppression.Conclusions:Unlike demyelinating ON, atypical ON requires treatment to preserve vision.     

Atypical optic neuritis: An overview

Optic neuritis (ON) refers to conditions that involve inflammation of the optic nerve. Various autoantibodies have been found, which are associated with central nervous system inflammatory disorders and have provided much information about the immune targets and mechanisms that impact the prognosis, treatment, and recurrence of atypical ON. Therefore, neurologists and ophthalmologists together should work to find out clinical, laboratory, and imaging findings that may provide important clues to the etiology of atypical ON and its management. Various biomarkers have been identified to confirm and distinguish atypical optic neuritis from others. The purpose of this review is to present the current scenario of atypical ON and its clinical management.     

The Use of Diffusion MRI in Ischemic Optic Neuropathy and Optic Neuritis

Ischemic optic neuropathy and optic neuritis are the most common causes of unilateral non-glaucomatous visual loss. While they have distinctive clinical features, they also share some overlapping profiles that make it difficult to clinically distinguish these two entities. MRI with gadolinium has been proven to be helpful to confirm the diagnosis of optic neuritis, but ischemic optic neuropathy remains a clinical diagnosis. Diffusion MRI, a newly advanced technique, has been used in studying the pathophysiology of optic neuritis, but its use in ischemic optic neuropathy is limited. Diffuse MRI may potentially be of help to diagnose ischemic optic neuropathy.     

非典型视神经炎的诊断及治疗研究进展

视神经炎( optic neuritis,ON)是导致青、中年人群视力丧失的最常见神经眼科疾病之一。以往简单地按照发病部位分类诊断,未从发病机制及临床特征区分,已不能满足目前临床诊疗需求。结合病因学、临床特征及预后,目前国际最新的分类诊断为典型ON及非典型ON。典型ON特指与多发性硬化( multiple sclerosis,MS)或中枢神经系统脱髓鞘疾病相关,治疗效果及预后相对良好。而非典型ON 病因复杂,临床表现、治疗方法、预后亦不尽相同。目前国际上有多个ON治疗方面的Ⅰ级循证医学证据,但鉴于遗传背景、地理环境及种族不同,尚无定论。我国缺乏此类多中心、大样本、大范围的研究证据,我们对ON,特别是非典型ON的诊疗进展作一综述,为进一步提高其临床诊疗的规范化与个体化提供一些建议。     

Orbital and adnexal cysticercosis

Orbital and adnexal cysticercosis is emerging as a far commoner disease than previously considered, both in endemic and nonendemic areas of cysticercosis. A review of the literature on orbital and adnexal cysticercosis found that it has a predilection for children and young adults with no definite sex predilection. The extraocular muscle form is the commonest type of orbital and adnexal cysticercosis. Lodgement of cysts in the subconjunctival space is another common site, followed by the eyelid, optic nerve, retro-orbital space and lacrimal gland. Association of orbital cysticercosis with systemic cysticercosis is quite rare. The clinical manifestations of orbital or adnexal cysticercosis are entirely different and depend on the location, size, relation to adjacent structures and stage of evolution of the cyst. Diagnosis of cysticercosis is based mainly on orbital imaging because of its highly specific appearance. Tissue diagnosis is not essential for initiating treatment. Medical therapy is the recommended treatment for the extraocular muscle form and retro-orbital cysticer-cosis. Surgical removal is advocated for subconjunctival and eyelid cysticercosis. Because of the limited number of cases of optic nerve and lacrimal gland cysticercosis, their treatment is controversial.     

视神经炎流行病学的研究进展

视神经炎是青壮年视力丧失的重要神经眼科疾病之一。不同国家及地区的视神经炎流行情况存在着明显差异。本文复习近年来国内外相关文献,从视神经炎的病因和流行病学特点等方面进行综述,为我国跨地区、多中心合作的视神经炎流行病学调查提供参考和比较。