Alves José Miguel, Seabra Mafalda, Braz Luís, Guimarães Joana
Faculty of Medicine of the University of Porto, Portugal.
Faculty of Medicine of the University of Porto, Portugal; Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal.
Mult Scler Relat Disord. 2020 Sep;44:102337. doi: 10.1016/j.msard.2020.102337. Epub 2020 Jun 25.
Optic neuropathies (ON) have several aetiologies and sometimes the diagnosis established ab initio is redefined after further investigations and/or new neurological events. We aim with this study to report clinical, paraclinical findings, treatment choices and disease course in patients admitted with a suspicion of acute or subacute optic neuropathy and to explore the diagnosis redefinition during follow-up and evaluate possible predictive factors that may influence that change.
We retrospectively reviewed the medical records of 156 patients with ON admitted to the ward of our Neurology Department, between January 2004 and August 2019. Clinical, laboratory and imaging data, as well as treatment protocols and follow-up were analysed.
At the time of discharge from the ward, our cohort comprised 83 idiopathic ON (53.2%), 38 multiple sclerosis-related ON (24.4%), 23 ischemic ON (14.7%), 5 neuromyelitis optica spectrum disorder-related ON (3.2%), 1 Chronic relapsing inflammatory optic neuropathy (0.6%), 1 Leber hereditary optic neuropathy (0.6%), 1 vitamin B12 deficiency ON (0.6%), 2 Behçet ON (1.3%), 1 systemic lupus erythematosus - associated ON (0.6%), 1 syphilitic ON (0.6%). During follow-up, 129 patients retained the ward's discharge diagnosis (82.7%) while in 27 it was redefined (17.3%). The median time between admission and change in diagnosis was 12.3 (5.4 - 42.9) months. 67.1% of valid patients manifested atypical characteristics of optic neuritis (presence of one of the following clinical findings: bilateral eye involvement, visual acuity ≤ 0.1 at admission, worsening or non-substantial recovery of visual acuity during hospitalization), while only 32.9% presented with ON typical for optic neuritis. Idiopathic ON was the "etiology" at discharge that changed the most during follow-up both in ON typical and atypical for optic neuritis. More than a half of the individuals with MS-RON in our study presented visual acuity at admission ≤ 0.1. Multivariate Cox regression analysis demonstrated that the patients with ON atypical for optic neuritis had lower risk of having the initial diagnosis changed (HR = 0.320, 95% CI = 0.138-0.743, p = 0.008).
Our study illustrates that some patients admitted with ON may have their diagnosis redefined during follow-up and it demonstrates that patients with ON atypical for optic neuritis are those in which the diagnosis is more likely to remain during follow-up. Furthermore, our population has clinical and paraclinical characteristics that reinforce conclusions from previous international studies.
视神经病变（ON）有多种病因，有时最初做出的诊断会在进一步检查和/或出现新的神经学事件后重新定义。我们开展这项研究的目的是报告疑似急性或亚急性视神经病变患者的临床、辅助检查结果、治疗选择及病程，并探讨随访期间诊断的重新定义情况，评估可能影响这一变化的预测因素。
我们回顾性分析了2004年1月至2019年8月间入住我院神经内科病房的156例视神经病变患者的病历。分析了临床、实验室及影像学数据，以及治疗方案和随访情况。
在病房出院时，我们的队列包括83例特发性ON（53.2%）、38例多发性硬化相关ON（24.4%）、23例缺血性ON（14.7%）、5例视神经脊髓炎谱系障碍相关ON（3.2%）、1例慢性复发性炎性视神经病变（0.6%）、1例Leber遗传性视神经病变（0.6%）、1例维生素B12缺乏性ON（0.6%）、2例白塞病性ON（1.3%）、1例系统性红斑狼疮相关性ON（0.6%）、1例梅毒性ON（0.6%）。随访期间，129例患者维持了病房出院时的诊断（82.7%），而27例患者的诊断被重新定义（17.3%）。入院至诊断改变的中位时间为12.3（5.4 - 42.9）个月。67.1%的有效患者表现出视神经炎的非典型特征（存在以下临床发现之一：双眼受累、入院时视力≤0.1、住院期间视力恶化或未显著恢复），而只有32.9%的患者表现出典型的视神经炎ON。特发性ON是随访期间在典型和非典型视神经炎ON中出院时“病因”变化最大的。我们研究中超过一半的MS - RON患者入院时视力≤0.1。多因素Cox回归分析表明，非典型视神经炎ON患者初始诊断改变的风险较低（HR = 0.320，95%CI = 0.138 - 0.743，p = 0.008）。
我们的研究表明，一些因ON入院的患者在随访期间可能会重新定义诊断，并且表明非典型视神经炎ON患者在随访期间诊断更有可能维持不变。此外，我们的研究人群具有临床和辅助检查特征，强化了先前国际研究的结论。
