MR of vasculitis-induced optic neuropathy

Documenta Ophthalmologica, 1987

Optic disc vasculitis is an idiopathic, usually benign condition in young healthy adults.

Chinese Journal of Academic Radiology, 2020

Optic neuritis is a common cause of vision loss, but it is difficult to visualize the lesion well via conventional magnetic resonance imaging due to its small size and oblique orientations of the optic nerves. Some advanced techniques have been introduced into clinical practice in recent decades. Herein we review recent advances in magnetic resonance imaging techniques that are useful in cases of optic neuritis.

Annals of Neurology, 1997

We found 42 of 7 4 patients (57%) with isolated monosymptomatic optic neuritis to have 1 to 20 brain lesions, by magnetic resonance imaging (MRI). All of the brain lesions were clinically silent and had characteristics consistent with multiple sclerosis (MS). None of the patients had ever experienced neurologic symptoms prior to the episode of optic neuritis. During 5.6 years of follow-up, 21 patients (28%) developed definite MS on clinical grounds. Sixteen of the 21 converting patients (76%) had abnormal MRIs; the other 5 (24%) had MRIs that were normal initially (when they had optic neuritis only) and when repeated after they had developed clinical MS in 4 of the 5. Of the 53 patients who have not developed clinically definite MS, 26 (49%) have abnormal MRIs and 27 (51%) have normal MRIs. The finding of an abnormal MRI at the time of optic neuritis was significantly related to the subsequent development of MS on clinical grounds, but interpretation of the strength of that relationship must be tempered by the fact that some of the converting patients had normal MFUs and approximately half of the patients who did not develop clinical MS had abnormal MRIs.

Neuroimage, 2008

Neuritis of the optic nerve is one of the most frequent early symptoms of multiple sclerosis. There are only scarce data correlating magnetic resonance imaging (MRI) contrast alterations with the underlying pathology, that is inflammation, demyelination, and axonal damage.

Brain, 2002

The location and extent of an abnormal signal on MRI of the optic nerve affected by optic neuritis are said to correlate with the severity of initial visual loss and recovery. We used gadolinium-enhanced fat-suppressed MRI to show abnormal enhancement of the optic nerve to determine the sensitivity of this modality in acute optic neuritis and whether the abnormal enhancement correlates with presenting visual de®cits or recovery. A total of 107 patients, 93 with follow-up (68 steroid treated), were included; 101 patients had enhancement of the affected optic nerve and no unaffected nerve enhanced. The baseline visual performance was similar between nerves with and without enhancement. Optic nerves with enhancement in the optic canal had poorer colour vision (P = 0.04) and nerves with all segments involved had worse threshold perimetry (P = 0.001) and colour vision (P = 0.008). Nerves with enhancement >10 mm had worse threshold perimetry (P = 0.004), while nerves with enhancing segments >17 mm had poorer baseline visual acuity (P = 0.02), threshold perimetry (P = 0.009) and colour vision (P = 0.01). For all parameters of vision, recovery was similar regardless of location or length of abnormal enhancement. Abnormal contrast enhancement of the optic nerve is a sensitive (94%) ®nding in acute optic neuritis and is absent in unaffected or previously affected optic nerves. Although lesions involving the canal or longer segments of optic nerve have worse starting vision, the location and length of enhancement are not predictive of recovery. Abbreviations: ANOVA = analysis of variance; CV = colour vision; dB = decibel; MD = mean deviation; STIR = short inversion recovery; VA = visual acuity ã Guarantors of Brain 2002 Brain (2002), 125, 812±822 Katz D, Taubenberger JK, Cannella B, McFarlin DE, Raine CS, McFarland HF. Correlation between magnetic resonance imaging ®ndings and lesion development in chronic, active multiple sclerosis. Ann Neurol 1993; 34: 661±9. Keltner JL, Johnson CA, Spurr JO, Beck RW. Visual ®eld pro®le of optic neuritis. One-year follow-up in the Optic Neuritis Treatment Trial. Arch Ophthalmol 1994; 112: 946±53. Kermode AG, Thompson AJ, Tofts P, McManus DG, Kendall BE, Kingsley DP, et al. Breakdown of the blood±brain barrier precedes symptoms and other MRI signs of new lesions in multiple sclerosis. Brain 1990; 133: 1477±89. Lee DH, Simon JH, Szumowski J, Feasby TE, Karlik SJ, Fox AJ, Pelz DM. Optic neuritis and orbital lesions: lipid-suppressed chemical shift MR imaging. Radiology 1991; 179: 543±6.

Journal of Neurology, Neurosurgery & Psychiatry, 1986

Thirty five adults and two children with clinically isolated optic neuritis were examined by magnetic resonance imaging (MRI) to determine the presence of disseminated lesions within the brain at presentation and to compare these findings with the results of evoked potential studies. Of the adult patients, 61% showed lesions on the scans whereas the evoked potentials suggested the presence of lesions outside the visual system in 30%. MRI is a sensitive method for the demonstration of clinically unsuspected lesions in patients with uncomplicated optic neuritis.

Acta Neurologica Scandinavica, 1987

Magnetic resonance imaging (MRI), multimodal evoked responses (ER) and HLA antigens were examined in 10 patients with idiopathic acute optic neuritis (ON) without any clinical symptoms or signs of multiple sclerosis (MS) during 9-14 years. In MRI, abnormalities compatible with MS were seen in 4 patients. In spite of clinically unilateral ON, a bilatera! abnormality in visual evoked responses (VER) was seen in 3 of 9 cases. Brain stem auditory evoked responses (BAER) were normal in all cases, short latency somatosensory evoked response (SER) in all but one. The cerebrospinal fluid at time of ON showed signs of demyelination in one case only. The frequency of HLA antigens DR2 (78%) and B18 (40%) was significantly increased in comparison to healthy controls. MRI seems to be the most sensitive method in the detection of cerebral lesions of MS, especially in mild or asymptomatic forms of the disease. The present techniques are, however, mostly unable to demonstrate optic nerve lesions which more reliably can be evaluated by VERs. The question whether idiopathic ON represents a form of MS solely, cannot be resolved.

Acta Clin Croat, 2007

Idiopathic optic neuritis is idiopathic inflammation of the optic nerve. Multiple sclerosis is a chronic inflammatory demyelinating process of the central nervous system that affects mostly women aged 20-40. Modern diagnostic methods (MRI, VEP, and computerized perimetry) can confirm or exclude demyelinating etiology of the process. The study included 31 patients with optic neuritis hospitalized at University Department of Ophthalmology, Split University Hospital in Split, Croatia, between January 1, 2004 and December 31, 2005. The incidence of idiopathic optic neuropathy at Department was 3.2/ 100,000 in 2004 and 3.4/100,000 in 2005. The majority of patients were in the 20-40 age group. In 22 (84.62%) patients, MRI showed brain demyelinating lesions. Most patients had prolonged VEP latencies. The incidence of idiopathic optic neuropathy has shown a significant increase in the last two years. Brain MRI was the key diagnostic method, along with significant symptoms and signs of idiopathic optic neuropathy. High dose corticosteroid pulse therapy, as described before, was demonstrated to have a beneficial effect on quick recovery of visual acuity and lengthening of relapse-free period.

Perspectives in Medicine, 2012

Background: Optic Neuritis (ONe) is common in Multiple Sclerosis (MS). The aim of this study was to evaluate the Optic Nerve (ONr) and its vascularisation in MS patients with and without previous ONe and in Healthy Controls (HC). Methods: We performed high-resolution echo-color ultrasound examination in 50 subjects (29 MS patients and 21 HC). By a suprabulbar approach we measured the ONr diameter at 3 mm from the retinal plane and at another unfixed point. We assessed the flow velocities of Ophthalmic Artery (OA), Central Retinal Artery (CRA) and Central Retinal Vein (CRV) measuring the Peak Systolic Velocity (PSV) and the End Diastolic Velocity (EDV) for the arteries and the Maximal Velocity (MaxV), Minimal Velocity (MinV) and mean Velocity (mV) for the veins. The Pulsatility Index (PI) and the Resistive Index (RI) were also calculated. Results: No significant variation for OA supply was found as well as no significant variation for CRA supply, while significant higher PI in the CRV of non-ONe MS eyes vs. both HC and ONe MS eyes was measured. We found that ONr diameter was decreased significantly from HC to non-ONe MS eyes and ONe MS eyes. Conclusions: Ultrasound examination of ONr and its vascularisation is feasible and can demonstrate ON atrophy. The increase of CRV PI in unaffected eyes of MS patients is intriguing and seems not associated to ONr atrophy. Larger studies are needed to confirm these results.

European Neurology, 2001