Kurne Asli, Karabudak Rana, Yalcin-Cakmakli Gul, Gursoy-Ozdemir Yasemin, Aydin Pinar, Ilksen-Colpak Ayse, Lule Sevda, Kansu Tulay
Department of Neurology.
Special Eye Clinic, Ankara, Turkey.
Eye Brain. 2010 Mar 5;2:15-20. doi: 10.2147/eb.s8888. eCollection 2010.
Optic neuritis (ON) can be recurrent, with unilateral or bilateral presentation. Diagnosis of recurrent cases may be challenging. In this study long-term follow-up of recurrent and/or bilateral ON patients is reported in an effort to guide differential diagnosis and treatment.
The study included 474 optic neuropathy patients. Of these, 70 patients with recurrent unilateral or bilateral, and nonrecurrent bilateral ON were assessed. The characteristics of each ON attack, laboratory and magnetic resonance imaging (MRI) findings, associated diseases and response to treatment were noted for each patient. Most of the patients were reevaluated in the outpatient clinic. Seven patients were investigated for neuromyelitis optica (NMO)-immunoglobulin G (IgG) seropositivity.
Forty-seven patients had recurrent unilateral ON and 23 had bilateral ON. Mean follow-up was 7.55 years. Final diagnoses for recurrent unilateral group were multiple sclerosis (MS) (n = 29), chronic relapsing inflammatory optic neuritis (CRION) (n = 11), NMO (n = 4), or autoimmune thyroid disease (n = 3); and for bilateral ON group, MS (n = 4), vasculitis (n = 13), postinfectious ON (n = 4), and sarcoidosis (n = 2). Three patients were positive for NMO antibodies.
Based on the data collected, we conclude when recurrent ON causes moderate to severe visual loss in the absence of cranial MRI findings typical of MS, other diagnoses should be considered, including NMO.
视神经炎（ON）可能会复发，可单侧或双侧发病。复发病例的诊断可能具有挑战性。在本研究中，我们报告了复发性和/或双侧ON患者的长期随访情况，以指导鉴别诊断和治疗。
该研究纳入了474例视神经病变患者。其中，对70例复发性单侧或双侧以及非复发性双侧ON患者进行了评估。记录了每位患者每次ON发作的特征、实验室检查和磁共振成像（MRI）结果、相关疾病以及对治疗的反应。大多数患者在门诊进行了重新评估。对7例患者进行了视神经脊髓炎（NMO）-免疫球蛋白G（IgG）血清学阳性检测。
47例患者为复发性单侧ON，23例为双侧ON。平均随访时间为7.55年。复发性单侧组的最终诊断为多发性硬化（MS）（n = 29）、慢性复发性炎性视神经炎（CRION）（n = 11）、NMO（n = 4）或自身免疫性甲状腺疾病（n = 3）；双侧ON组的诊断为MS（n = 4）、血管炎（n = 13）、感染后ON（n = 4）和结节病（n = 2）。3例患者NMO抗体呈阳性。
基于收集到的数据，我们得出结论，当复发性ON在没有典型MS的头颅MRI表现情况下导致中度至重度视力丧失时，应考虑其他诊断，包括NMO。
