视神经脊髓炎和多发性硬化临床分析和眼部特点

目的 比较视神经脊髓炎(NMO)和多发性硬化(MS)临床表现、眼部发病特点、影像学和病情转归的异同.方法 回顾性收集1998年1月至2007年12月期间24例(43只眼)NMO和累及视神经MS40例(68只眼)患者,分析比较二种疾病在全身和眼部发病特征、视神经炎治疗预后与病情转归.结果 NMO随访时间中位数7年,MS组中位数5年,二者差异无统计学意义(P=0.81).NMO与MS均多见于中青年女性患者,且视神经炎多双眼受累.但是,视神经炎的发作具有不同的特点,NMO组83.3%(20/24)患者以视神经炎为首发症状或同时合并其它部位发病,MS组较低为60%(24/40);与MS比较,NMO组首次视神经炎发作视力下降更为急剧,双眼先后或同时受累,治疗效果较差.NMO组脊髓核磁共振成像(MRI)常见等于或大于3个脊髓节段的纵向融合病灶,未见脑MRI特异性病变表现;MS组脊髓MRI少见超过1个脊髓节段病灶,部分MS患者脑MRI可见异常病灶.结论 NMO常见视神经炎首发,双眼先后或同时受累,视神经炎呈爆发性、灾难性发作,视力预后差,MRI表现大型纵向融合脊髓病灶,NMO可能是独立于MS的疾病.

Clinical and ocular manifestation of neuromyelitis optica and multiple sclerosis

Objective To investigate the difference of neuromyelitis optica (NMO) and multiple sclerosis (MS) with clinical and ocular manifestation, imaging features, medical effect and results. Methods Collection of 24 (43 eyes) NMO and 40 (68 eyes) MS in-patient cases which were admitted from January, 1998 to December, 2007. Those systemic and ocular symptoms and therapies were analyzed retrospectively. Results NMO and MS were commonly seen in adulthood females. 83.3% (20/24)of the NMO patients initially broke out as optic neuritis (ON) or systemic symptoms simultaneously. Compared with MS, the visual acuity with ON after the first attack drastically deteriorate and characterized by monophasic course or recurrent relapses with concomitant involvement of either unilateral or bilateral eye, and with very poor prognosis. Spinal cord Magnetic resonance imaging (MRI) in NMO were extended over 3 or more consecutive segments, in contrast, MS rarely exceeded one vertebral segments. MRI findings of the brain in NMO were typically normal, but brain lesions had been seen on MRI in some MS patients. Conclusions NMO is commonly initially broke out as ON.ON is characterized by monophasic course or recurrent relapses with concomitant involvement of either unilateral or bilateral. ON can be fulminate and devastating and very poor prognosis. Spinal cord MRI can be extended over 3 or more consecutive segments. NMO may be distinguished from MS.