Clinical Analysis Of 32 Cases Of Suspected Optic Neuritis

Objective:To clear the diagnosis in the light of internationally accepted diagnostic criteria for optic neuritis,and try to find etiology of the disease through the analysis of detailed history taking,ophthalmology and neurology clinical examination, ophthalmic examination,imaging and the blood,cerebrospinal fluid laboratory test, etc.of patients with suspected diagnosed optic neuritis.Make long-term follow-up of patients to track the recurrence and prognosis of disease.Discuss the relationship between the viral infection,immune response,systemic diseases and the diagnosis, treatment,prognosis of optic neuritis.Subjects and Methods:Subjects:A total of 32 cases and 43 eyes of newly diagnosed patients with suspected optic neuritis,who visit Fudan University Huashan Hospital ophthalmology,between March 2008 to March 2009,Aged 15-57 years old,at the average of 38.25±13.1.8 males(25%),24 female(75%).11 cases in both eyes(34.4%) and 21 cases of monocular(65.6%).Methods:Take history,ophthalmic and supplementary examinations such as vision,fundus oculi,visual field,VEP,ect.and the fundus fluorescein angiography,MRI or other imaging examinations for the patients if necessary.Test the erythrocyte sedimentation rate,blood glucose,liver and kidney function,hormone levels,rheumatoid factor,immune factors,blood NMO-IgG. Neurological routine medical consultation,take the lumbar puncture to get cerebrospinal fluid test,IgG-Index+OB,ect.To clear the diagnosis follow the diagnostic criteria of the United States Optic Neuritis Treatment Trial according to the results and explore the relevant factors of the disease.Results:A total of 32 cases and 43 eyes to be diagnosed as suspected optic neuritis, with the average visual impairment serious than foreign countries.60.6%patients have pupil movement disorder,mainly the disappearance of pupillary light reflex and RAPD(+).Fundus optic disc edema accounted for 46.9%.There are many form of visual field defect,the most common is diffuse defect.VEP visual evoked potential show varying degrees of abnormal changes,in 18 cases of patients with severe visual impairment as a result,P-VEP waveform can not lead to clear,and the remaining patients showed extension of P100 wave latency and P100 wave amplitude decreased. Take FFA to identify ischemic optic neuropathy have greater significance.MRI examination revealed one case of placeholder of sellar region,one fibroids of optic nerve,as well as three cases of multiple sclerosis and one case of neuromyelitis optica. Laboratory examination found 8 cases of patients with elevated prolactin levels,10 cases of higher vasculitis indicators,11 cases with immune disorders.Cerebrospinal fluid examination in 19 cases of patients found seven(36.8%) with normal,and the remaining had different types of abnormal performance.NMO-IgG detection see two cases of positive,three cases of suspected positive,and the remaining negative. According to the examinations,ultimately there were 25 patients with the clinical diagnosis of optic neuritis,in which 8 patients had previous history of similar attacks. There were 18 cases of patients with idiopathic optic neuritis,3 cases of a clear diagnosis of multiple sclerosis;and 1 of neuromyelitis optica.Consider 2 cases of patients with autoimmune diseases,including one ankylosing spondylitis,and the other suspected SLE,also consider one cases of syphilitic optic neuritis.A total of seven cases of suspected optic neuritis ended up to excluded the diagnosis.Edema of the optic disc and visual decline caused by ischemic optic neuropathy was common.(4 cases).1 case was hereditary optic neuropathy Leber's disease,1 case was the optic nerve fibroma and still 1 cases of sellar area space-occupying lesions.13 cases (40.6%) has poor prognosis in the final,of which four was non-optic neuritis.Conclusion:The most common type of optic neuritis is idiopathic optic neuritis,and it go far close to the central nervous system demyelinating disease,such as multiple sclerosis and neuromyelitis optica.Optic neuritis of unknown etiology should be establishing a long-term follow-up system.Systemic autoimmune diseases,syphilis and some vascular inflammatory disease can lead to the occurrence of acute optic neuritis.Ischemic optic neuropathy,Leber's hereditary optic neuropathy,and many other space-occupying lesions could be confused with optic neuritis,and we should pay attention to the differential in our clinical work.High prolactin levels may increase the risk of optic neuritis.Abnormal vasculitis and immune parameters in patients may suggest recurrence of optic neuritis or poor prognosis.The level of visual impairment at the beginning,the head MRI,vasculitis indicators,immune disorders,CSF OB,NMO-IgG can probably determine the prognosis of optic neuritis patients.