Die Neuritis nervi optici

 

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Zusammenfassung

Die akute Neuritis nervi optici ist eine klinische Diagnose und typischerweise durch eine vor allem bei Augenbewegung schmerzhafte Sehminderung charakterisiert. Häufig ist sie Ausdruck einer entzündlichen Systemerkrankung, insbesondere der Multiplen Sklerose. Untypische Verläufe wie das beidseitige Auftreten, ein ungewöhnliches Erkrankungsalter oder klinische Präsentation wie auch systemische und neurologische Begleitsymptome erfordern differenzialdiagnostische Überlegungen. Neben der routinemäßigen neurologisch-klinischen Untersuchung hat sich die MRT des Kopfes als Standarddiagnostik etabliert. Die Bildgebung ermöglicht neben der Lumbalpunktion eine Aussage über das Multiple-Sklerose-Risiko. Die Zusatzdiagnostik bei akuter Neuritis nervi optici hat in den letzten Jahren in der Entscheidung über die immunmodulatorische Frühbehandlung des klinisch isolierten Syndroms an Bedeutung gewonnen. Weitere serologische und bildgebende Untersuchungen im Zusammenhang mit einer Neuritis nervi optici haben bei Verdacht auf eine infektiöse Ursache, eine Sarkoidose oder systemische Autoimmunerkrankung ihren differenzialdiagnostischen Stellenwert.

Abstract

The diagnosis of optic neuritis (ON) is made clinically based on typical signs and symptoms such as reduced vision and painful eye movements. Very often, ON is part of or associated with a systemic disease, in particular, multiple sclerosis (MS). Differential diagnosis is necessary in untypical cases with bilateral involvement, unusual age at manifestation or associated systemic and/or neurological symptoms. Neurological examination and cerebral MRI are standard in ON work-up. CSF analysis together with MRI scans allows MS risk assessment in ON patients. Further work-up is necessary in suspected systemic autoimmune disorders, sarcoidosis or infectious causes of ON such as borreliosis.

Literatur

• 1 Gerling J, Janknecht P, Hansen L L et al. Diameter of the optic nerve in idiopathic optic neuritis and in anterior ischemic optic neuropathy.  Int Ophthalmol. 1997;  21 131-135
  Google Scholar
• 2 Stammen J, Unsold R, Arendt G et al. Etiology and pathogenetic mechanisms of optic disc swelling with visual loss. An interdisciplinary prospective pilot study of 102 cases.  Ophthalmologica. 1999;  213 40-47
  Google Scholar
• 3 Beck R W, Cleary P A, Trobe J D et al. The effect of corticosteroids for acute optic neuritis on the subsequent development of multiple sclerosis. The Optic Neuritis Study Group.  N Engl J Med. 1993;  329 1764-1769
  Google Scholar
• 4 Beck R W, Trobe J D, Moke P S et al. High- and low-risk profiles for the development of multiple sclerosis within 10 years after optic neuritis: experience of the optic neuritis treatment trial.  Arch Ophthalmol. 2003;  121 944-949
  Google Scholar
• 5 Optic Neuritis Study Group . Multiple sclerosis risk after optic neuritis: final optic neuritis treatment trial follow-up.  Arch Neurol. 2008;  65 727-732
  Google Scholar
• 6 Optic Neuritis Study Group . The clinical profile of optic neuritis. Experience of the Optic Neuritis Treatment Trial.  Arch Ophthalmol. 1991;  109 1673-1678
  Google Scholar
• 7 Rodriguez M, Siva A, Cross S A et al. Optic neuritis: a population-based study in Olmsted County, Minnesota.  Neurology. 1995;  45 244-250
  Google Scholar
• 8 Jin Y P, Pedro-Cuesta de J, Soderstrom M et al. Incidence of optic neuritis in Stockholm, Sweden, 1990 – 1995: II. Time and space patterns.  Arch Neurol. 1999;  56 975-980
  Google Scholar
• 9 Jin Y P, Pedro-Cuesta de J, Soderstrom M et al. Incidence of optic neuritis in Stockholm, Sweden 1990 – 1995: I. Age, sex, birth and ethnic-group related patterns.  J Neurol Sci. 1998;  159 107-114
  Google Scholar
• 10 Schumacher G A, Beebe G, Kibler R F et al. Problems of Experimental Trials of Therapy in Multiple Sclerosis: Report by the Panel on the Evaluation of Experimental Trials of Therapy in Multiple Sclerosis.  Ann N Y Acad Sci. 1965;  122 552-568
  Google Scholar
• 11 McDonald W I, Compston A, Edan G et al. Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis.  Ann Neurol. 2001;  50 121-127
  Google Scholar
• 12 Hickman S J, Dalton C M, Miller D H et al. Management of acute optic neuritis.  Lancet. 2002;  360 1953-1962
  Google Scholar
• 13 Chan J W. Optic nerve disorders. New York: Springer; 2007: 1-129
  Google Scholar
• 14 Cleary P A, Beck R W, Bourque L B et al. Visual symptoms after optic neuritis. Results from the Optic Neuritis Treatment Trial.  J Neuroophthalmol. 1997;  17 18-23
  Google Scholar
• 15 Wildberger H. Optikusneuritis. In Huber A, Kömpf D, eds Klinische Neuroophthalmologie.. Stuttgart, New York: Georg Thieme Verlag; 1998: 288-299
  Google Scholar
• 16 Slamovitis T L, Rosen C E, Cheng K P et al. Visual recovery in patients with optic neuritis and visual loss to no light perception.  Am J Ophthalmol. 1991;  111 209-214
  Google Scholar
• 17 Silverman S E, Hart Jr W M, Gordon M O et al. The dyschromatopsia of optic neuritis is determined in part by the foveal/perifoveal distribution of visual field damage.  Invest Ophthalmol Vis Sci. 1990;  31 1895-1902
  Google Scholar
• 18 Flanagan P, Markulev C. Spatio-temporal selectivity of loss of colour and luminance contrast sensitivity with multiple sclerosis and optic neuritis.  Ophthalmic Physiol Opt. 2005;  25 57-65
  Google Scholar
• 19 Moura A L, Teixeira R A, Oiwa N N et al. Chromatic discrimination losses in multiple sclerosis patients with and without optic neuritis using the Cambridge Colour Test.  Vis Neurosci. 2008;  25 463-468
  Google Scholar
• 20 Kawasaki A, Purvin V A. Idiopathic chiasmal neuritis: clinical features and prognosis.  Arch Ophthalmol. 2009;  127 76-81
  Google Scholar
• 21 Lightman S, McDonald W I, Bird A C et al. Retinal venous sheathing in optic neuritis. Its significance for the pathogenesis of multiple sclerosis.  Brain. 1987;  110 (Pt 2) 405-414
  Google Scholar
• 22 Compston A. From the archives. Retinal venous sheating in optic neuritis. By S. Lightman et al.  Brain. 2010;  133 1573-1574
  Google Scholar
• 23 Lagreze W A. Differentialdiagnose der Papillenschwellung.  Ophthalmologe. 2001;  98 417-431
  Google Scholar
• 24 Purvin V, Kawasaki A, Jacobson D M. Optic perineuritis: clinical and radiographic features.  Arch Ophthalmol. 2001;  119 1299-1306
  Google Scholar
• 25 Brodsky M C. Pediatric Neuroophthalmology. New York: Springer; 2010 2 ed
  Google Scholar
• 26 Holder G E. Electrophysiological assessment of optic nerve disease.  Eye. 2004;  18 1133-1143
  Google Scholar
• 27 Halliday A M, McDonald W I, Mushin J. Visual evoked response in diagnosis of multiple sclerosis.  Br Med J. 1973;  4 661-664
  Google Scholar
• 28 Halliday A M, McDonald W I, Mushin J. Delayed visual evoked response in optic neuritis.  Lancet. 1972;  1 982-985
  Google Scholar
• 29 Fisher J B, Jacobs D A, Markowitz C E et al. Relation of visual function to retinal nerve fiber layer thickness in multiple sclerosis.  Ophthalmology. 2006;  113 324-332
  Google Scholar
• 30 Rejdak K, Jackson S, Giovannoni G. Multiple sclerosis: a practical overview for clinicians.  Br Med Bull. 2010;  95 79-104
  Google Scholar
• 31 Henze T. Symptomatische Therapie der Multiplen Sklerose.  Nervenarzt. 2004;  75 (Suppl 1) 2-39
  Google Scholar
• 32 Filippi M, Rocca M A. Conventional MRI in multiple sclerosis.  J Neuroimaging. 2007;  17 (Suppl 1) 3S-9S
  Google Scholar
• 33 O’Riordan J I, Thompson A J, Kingsley D P et al. The prognostic value of brain MRI in clinically isolated syndromes of the CNS. A 10-year follow-up.  Brain. 1998;  121 (Pt 3) 495-503
  Google Scholar
• 34 Ormerod I E, Miller D H, McDonald W I et al. The role of NMR imaging in the assessment of multiple sclerosis and isolated neurological lesions. A quantitative study.  Brain. 1987;  110 (Pt 6) 1579-1616
  Google Scholar
• 35 Polman C H, Reingold S C, Edan G et al. Diagnostic criteria for multiple sclerosis: 2005 revisions to the ”McDonald Criteria”.  Ann Neurol. 2005;  58 840-846
  Google Scholar
• 36 Sahraian M A, Eshaghi A. Role of MRI in diagnosis and treatment of multiple sclerosis.  Clin Neurol Neurosurg. 2010;  112 609-615
  Google Scholar
• 37 Soderstrom M, Lindqvist M, Hillert J et al. Optic neuritis: findings on MRI, CSF examination and HLA class II typing in 60 patients and results of a short-term follow-up.  J Neurol. 1994;  241 391-397
  Google Scholar
• 38 Cole S R, Beck R W, Moke P S et al. The predictive value of CSF oligoclonal banding for MS 5 years after optic neuritis. Optic Neuritis Study Group.  Neurology. 1998;  51 885-887
  Google Scholar
• 39 Beck R W, Trobe J D. What we have learned from the Optic Neuritis Treatment Trial.  Ophthalmology. 1995;  102 1504-1508
  Google Scholar
• 40 Jacobs L D, Beck R W, Simon J H et al. Intramuscular interferon beta-1a therapy initiated during a first demyelinating event in multiple sclerosis. CHAMPS Study Group.  N Engl J Med. 2000;  343 898-904
  Google Scholar
• 41 Filippi M, Rovaris M, Inglese M et al. Interferon beta-1a for brain tissue loss in patients at presentation with syndromes suggestive of multiple sclerosis: a randomised, double-blind, placebo-controlled trial.  Lancet. 2004;  364 1489-1496
  Google Scholar
• 42 Kappos L, Polman C H, Freedman M S et al. Treatment with interferon beta-1b delays conversion to clinically definite and McDonald MS in patients with clinically isolated syndromes.  Neurology. 2006;  67 1242-1249
  Google Scholar
• 43 Comi G, Martinelli V, Rodegher M et al. Effect of glatiramer acetate on conversion to clinically definite multiple sclerosis in patients with clinically isolated syndrome (PreCISe study): a randomised, double-blind, placebo-controlled trial.  Lancet. 2009;  374 1503-1511
  Google Scholar
• 44 Linker R A, Kieseier B C. Therapieentscheidungen bei Multipler Sklerose.  Nervenarzt. 2008;  79 1123-1124,1126 – 1128
  Google Scholar
• 45 Mandler R N, Davis L E, Jeffery D R et al. Devic’s neuromyelitis optica: a clinicopathological study of 8 patients.  Ann Neurol. 1993;  34 162-168
  Google Scholar
• 46 Wingerchuk D M, Lennon V A, Pittock S J et al. Revised diagnostic criteria for neuromyelitis optica.  Neurology. 2006;  66 1485-1489
  Google Scholar
• 47 Wingerchuk D M, Hogancamp W F, O’Brien P C et al. The clinical course of neuromyelitis optica (Devic’s syndrome).  Neurology. 1999;  53 1107-1114
  Google Scholar
• 48 Zajicek J P, Scolding N J, Foster O et al. Central nervous system sarcoidosis – diagnosis and management.  Qjm. 1999;  92 103-117
  Google Scholar
• 49 Koczman J J, Rouleau J, Gaunt M et al. Neuro-ophthalmic sarcoidosis: the University of Iowa experience.  Semin Ophthalmol. 2008;  23 157-168
  Google Scholar
• 50 Pradella S P, Krause A, Muller A. Akute Borreliainfektion. Einseitige Papillitis als isolierte klinische Manifestation.  Ophthalmologe. 1997;  94 591-594
  Google Scholar
• 51 Burkhard C, Gleichmann M, Wilhelm H. Optic nerve lesion following neuroborreliosis: a case report.  Eur J Ophthalmol. 2001;  11 203-206
  Google Scholar
• 52 Mygland A, Ljostad U, Fingerle V et al. EFNS guidelines on the diagnosis and management of European Lyme neuroborreliosis.  Eur J Neurol. 2010;  17 8-16, e11 – 14
  Google Scholar
• 53 Boomer J A, Siatkowski R M. Optic neuritis in adults and children.  Semin Ophthalmol. 2003;  18 174-180
  Google Scholar
• 54 Selbst R G, Selhorst J B, Harbison J W et al. Parainfectious optic neuritis. Report and review following varicella.  Arch Neurol. 1983;  40 347-350
  Google Scholar
• 55 Tauber T, Turetz J, Barash J et al. Optic neuritis associated with etanercept therapy for juvenile arthritis.  J Aapos. 2006;  10 26-29
  Google Scholar
• 56 Zannin M E, Martini G, Buscain I et al. Sudden visual loss in a child with juvenile idiopathic arthritis-related uveitis.  Br J Ophthalmol. 2009;  93 282-283, 417
  Google Scholar
• 57 Morales D S, Siatkowski R M, Howard C W et al. Optic neuritis in children.  J Pediatr Ophthalmol Strabismus. 2000;  37 254-259
  Google Scholar
• 58 Deryck O, Ketelaer P, Dubois B. Clinical characteristics and long term prognosis in early onset multiple sclerosis.  J Neurol. 2006;  253 720-723
  Google Scholar
• 59 Simone I L, Carrara D, Tortorella C et al. Course and prognosis in early-onset MS: comparison with adult-onset forms.  Neurology. 2002;  59 1922-1928
  Google Scholar
• 60 Wilejto M, Shroff M, Buncic J R et al. The clinical features, MRI findings, and outcome of optic neuritis in children.  Neurology. 2006;  67 258-262
  Google Scholar
• 61 Zettl U K, Köhler W, Buchmann J. Klinik der MS im Kinder- und Jugendalter. Stuttgart- New York: Springer; 2007: 19-24
  Google Scholar
• 62 Absoud M, Cummins C, Desai N et al. Childhood optic neuritis clinical features and outcome.  Arch Dis Child. 2010 Jun 16. [Epub ahead of print]; 
  Google Scholar
• 63 Bonhomme G R, Waldman A T, Balcer L J et al. Pediatric optic neuritis: brain MRI abnormalities and risk of multiple sclerosis.  Neurology. 2009;  72 881-885
  Google Scholar
• 64 Shams P N, Plant G T. Optic neuritis: a review.  Int MS J. 2009;  16 82-89
  Google Scholar

PD Dr. Christina Gerth-Kahlert

Augenklinik, Universität Rostock

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