No abstract available.
Diagnosis* ; Optic Neuritis*

We performed full field pattern reversal VEP using UTAS-E 2000, in 87 eyes of the 70 patients with amblyopia(14 eyes) and optic nerve diseases; optic neuritis(21 eyes), optic nerve atrophy(23 eyes), toxic optic neuropathy(15 eyes) and optic nerve injury(14 eyes) from December 1993 to July 1994. This study was carried out to evaluate the relationship of the visual acuity with P1 amplitude, P1 latency, and to compare the latency of P1, and P1-N2 amplitude to each disease group and the normal groups. There was no correlation between the visual acuity and P1 latency, but significant correlation between the visual acuity and P1 amplitude(p<0.01). In the P1 implicit time, optic neuritis, optic nerve atrophy and toxic optic neuropathy patients presented marked delay and amblyopia patients presented moderate delay, but there was no other significant difference in each disease group. Over 50% of each disease group except amblyopia presented P1 destruction. Therefore, the authers concluded that P1 amplitude might not be good parameter in diagnosis of the optic nerve disease because of its variability to the visual acuity, but P1 latency and P1 destruction could be good parameter.
Amblyopia* ; Atrophy ; Diagnosis ; Humans ; Optic Nerve Diseases* ; Optic Nerve Injuries ; Optic Nerve* ; Optic Neuritis ; Visual Acuity

In order to investigate causative mechanisms of optic neuropathy, retrospective clinical studies including ophthalmologic examination, imaging study, and molecular biologic analyses were performed on 322 patients with optic neuropathy. The causes include hereditary optic neuropathy(71 patients, 22.1%), optic neuritis(66 patients, 20.5%), traumatic optic neuropathy(40 patients, 12.5%), ischemic optic neuropathy(35 patients, 10.9%), compressive optic neuropathy(31 patients, 9.6%), toxic optic neuropathy(23 patients, 7.1%), etc. In 29 patients of bilateral optic atrophy and 18 patients of unilateral optic atrophy, the causative mechanism was not clear. In conclusion, hereditary optic neuropathy was the most common causative mechanism of optic neuropathy in this study. The importance of meticulous history taking and molecular biologic test should be stressed in differential diagnosis of optic neuropathy.
Diagnosis, Differential ; Humans ; Optic Atrophy ; Optic Nerve Diseases* ; Optic Nerve Injuries ; Optic Neuritis ; Retrospective Studies

In order to investigate causative mechanisms of optic neuropathy, retrospective clinical studies including ophthalmologic examination, imaging study, and molecular biologic analyses were performed on 322 patients with optic neuropathy. The causes include hereditary optic neuropathy(71 patients, 22.1%), optic neuritis(66 patients, 20.5%), traumatic optic neuropathy(40 patients, 12.5%), ischemic optic neuropathy(35 patients, 10.9%), compressive optic neuropathy(31 patients, 9.6%), toxic optic neuropathy(23 patients, 7.1%), etc. In 29 patients of bilateral optic atrophy and 18 patients of unilateral optic atrophy, the causative mechanism was not clear. In conclusion, hereditary optic neuropathy was the most common causative mechanism of optic neuropathy in this study. The importance of meticulous history taking and molecular biologic test should be stressed in differential diagnosis of optic neuropathy.
Diagnosis, Differential ; Humans ; Optic Atrophy ; Optic Nerve Diseases* ; Optic Nerve Injuries ; Optic Neuritis ; Retrospective Studies

Leber's hereditary optic neuropathy is caused by a single nucleotide change in the mitochondrial deoxynucleic acid(mtDNA). We identified a single guanine to adenine transition mutation in the mitochondrial DNA at nucleotide position 11778(Wallace mutation)in a 13 year old boy. To our knowldge, this is the first report confirming mtDNA mutation in Korea. This would be very helpful for the correct diagnosis of optic neuritis, optic neuropathy and optic atrophy of unknown etiology as well as for genetic counselling in the future.
Adenine ; Adolescent ; Diagnosis ; DNA, Mitochondrial ; Guanine ; Humans ; Korea ; Male ; Optic Atrophy ; Optic Atrophy, Hereditary, Leber* ; Optic Nerve Diseases ; Optic Neuritis

PURPOSE: To compare the usefulness of combined fat- and fluid-suppressed selective partial inversion recovery-fluid attenuated inversion recovery(SPIR-FLAIR) images in the detection of high signal intensity of the optic nerve in optic neuritis with that of fat-suppressed selective partial inversion recovery(SPIR) or short inversion time inversion recovery(STIR) images. MATERIALS AND METHODS: Two radiologists independently analyzed randomly mixed MR images of 16 lesions in 14 patients (M:F=7:7; mean age, 40years) in whom optic neuritis had been clinically diagnosed. All subjects underwent both SPIR-FLAIR and fat-suppressed SPIR or STIR imaging, in a blind fashion. In order to evaluate the optic nerve, coronal images perpendicular to its long axis were obtained. The detection rate of high signal intensity of the optic nerve, the radiologists' preferred imaging sequences, and intersubject consistency of detection were evaluated. 'High signal intensity' was defined as the subjective visual evaluation of increased signal intensity compared with that of the contralateral optic nerve or that of white matter. RESULTS: The mean detection rate of high signal intensity of the optic nerve was 90% for combined fat- and fluid-suppressed SPIR-FLAIR images, and 59% for fat-suppressed SPIR or STIR images. In all cases in which the signal intensity observed on SPIR-FLAIR images was normal, that on fat-suppressed SPIR or STIR images was also normal. The radiologists preferred the contrast properties of SPIR-FLAIR to those of fat-suppressed SPIR or STIR images. CONCLUSION: In the diagnosis of optic neuritis using MRI, combined fat- and fluid-suppressed SPIR-FLAIR images were more useful for the detection of high signal intensity of the optic nerve than fat-suppressed SPIR or STIR images. For the evaluation of optic neuritis, combined fat- and fluid-suppressed SPIR-FLAIR imaging is superior to fat-suppressed SPIR or STIR imaging.
Axis, Cervical Vertebra ; Diagnosis ; Humans ; Magnetic Resonance Imaging ; Optic Nerve ; Optic Neuritis*

Hepatitis B ; diagnosis ; etiology ; Humans ; Male ; Middle Aged ; Neurosyphilis ; complications ; diagnosis ; Optic Neuritis ; complications ; diagnosis

PURPOSE: To report a case of optic neuritis difficult to differentiate from ischemic optic neuropathy and optic nerve glioma. CASE SUMMARY: A 63-year-old male visited our clinic because of a sudden painless decrease in visual acuity in his right eye. He had a relative afferent pupillary defect and inferior altitudinal scotoma with disc pallor in his right eye. Ischemic optic neuropathy was suspected based on these clinical observations. However, a focal enhancing lesion was found in the intracranial portion of the right optic nerve on gadolinium-enhanced T1-weighted MRI. The radiologist's report revealed right intracranial optic glioma. Optic neurectomy was planned in accordance with the suspicion for optic glioma. However, a systemic mega-dose methylprednisolone therapy which is relatively less invasive was performed first based on the decision that optic neuritis should be distinguished from optic nerve glioma. The patient was hospitalized and 1 gram of methylprednisolone was injected intravenously daily for 3 days. The patient's visual acuity in the right eye improved from 0.1 before treatment to 0.3 after treatment. MRI scans at 8 months after steroid treatment showed disappearance of the previously enhanced lesion suspicious for optic glioma with developed atrophic change. The patient was finally diagnosed with optic neuritis based on these results. CONCLUSIONS: Careful differential diagnoses and therapeutic approaches to possible diseases are necessary because optic neuritis can manifest as a variety of clinical entities and imaging findings.
Diagnosis, Differential ; Humans ; Magnetic Resonance Imaging ; Male ; Methylprednisolone ; Middle Aged ; Optic Nerve ; Optic Nerve Glioma* ; Optic Neuritis* ; Optic Neuropathy, Ischemic* ; Pallor ; Pupil Disorders ; Scotoma ; Visual Acuity

PURPOSE: The purpose of this study was to demonstrate whether the pattern of optic nerve enhancement in magnetic resonance imaging (MRI) can help to differentiate between idiopathic optic neuritis (ON), neuromyelitis optica (NMO), and multiple sclerosis (MS) in unilateral ON. METHODS: An MRI of the brain and orbits was obtained in patients with acute unilateral ON. Patients with ON were divided into three groups: NMO, MS, and idiopathic ON. The length and location of the abnormal optic nerve enhancement were compared for ON eyes with and without NMO or MS. The correlation between the pattern of optic nerve enhancement and the outcome of visual function was analyzed. RESULTS: Of the 36 patients with ON who underwent an MRI within 2 weeks of the onset, 19 were diagnosed with idiopathic ON, 9 with NMO, and 8 with MS. Enhancement of the optic nerve occurred in 21 patients (58.3%) and was limited to the orbital segment in 12 patients. Neither the length nor the location of the optic nerve enhancement was significantly correlated with visual functions other than contrast sensitivity or the diagnosis of idiopathic ON, MS, or NMO. Patients with greater extent of optic nerve sheath enhancement and more posterior segment involvement showed higher contrast sensitivity. CONCLUSIONS: Our data revealed that the pattern of optic nerve enhancement was not associated with diagnosis of idiopathic ON, NMO, or MS in Korean patients with unilateral ON. We believe further studies that include different ethnic groups will lead to a more definitive answer on this subject.
Brain ; Contrast Sensitivity ; Diagnosis ; Ethnic Groups ; Humans ; Magnetic Resonance Imaging ; Multiple Sclerosis ; Neuromyelitis Optica ; Optic Nerve* ; Optic Neuritis* ; Orbit

Optic neuritis refers to any inflammatory disorder of optic nerves, but it usually denotes an acute or subacute disease of optic nerves attributed to inflammation associated with demyelination. The diagnosis of optic neuritis is usually made on a clinical ground. The condition usually presents as a painful subacute unilateral loss of vision, which progresses over a few days to 2 weeks. The pain varies in severity, although it typically does not interfere with sleep. We report 2 cases of atypical optic neuritis rapidly recovered by the administration of high doses of steroid that presented with severe eyeball pain accompanied by vague visual loss and painlessly insidious onset of visual loss respectively, with normal findings in fundoscopic examinations, visual evoked potentials and orbital MRIs.
Child ; Demyelinating Diseases ; Diagnosis ; Evoked Potentials, Visual ; Humans ; Inflammation ; Magnetic Resonance Imaging ; Optic Nerve ; Optic Neuritis* ; Orbit