Optic neuritis--etiology?

Anticardiolipin antibodies in Japanese patients with multiple sclerosis

We evaluated circulating anticardiolipin antibodies (aCL) in 38 Japanese patients who fulfilled the criteria of clinically definite multiple sclerosis (MS), using a newly developed EIA system with aCL-cofactor. Two of 38 patients (5.3%) had a aCL-cofactor-dependent positive serology, and differences compared with findings in controls were statistically significant. The 2 aCL-positive patients had similar clinical features with acute transverse myelopathy (ATM), optic neuropathy (OPN), normal cranial MRI and negative oligoclonal IgG bands (OCBs) in the cerebrospinal fluid (CSF). Among the 38 patients, 3 had ATM, OPN, normal cranial MRI and negative OCBs, hence, in a significant number of the patients (2/3; 67%) with these distinctive features, serology for aCL was positive. Therefore, they may have another condition associated with aCL, masquerading as MS. Serological testing for aCL with aCL-cofactor is recommended for the patients with clinical diagnosis of MS, especially for those showing OPN and ATM during the clinical course, and in Asian peoples where the incidence of ATM and OPN is relatively high among the patients with diagnosis of MS.

Acute homonymous field loss: really a diagnostic dilemma

A young woman developed the sudden onset of a congruous right lower quadratic visual field defect two weeks prior to examination. The remainder of her history and physical examination were noncontributory. Discussion revolves around the differential diagnosis of retro chiasmal field defects in young individuals. An MRI scan was most compatible with the diagnosis of disseminated sclerosis.

Optic neuritis and myelopathy in systemic lupus erythematosus

The optic neuritis of systemic lupus erythematosus (S.L.E.) more frequently results in the persistence of a central scotoma or complete blindness after a single attack than demyelinating optic neuritis, although the initial clinical presentations may be identical. A significant number of patients, however, recover normal vision. Optic neuritis may be the presenting symptom of S.L.E. and as myelopathy may also occur in the course of the disease, confusion with multiple sclerosis may result, especially if there are no arthritic, cutaneous nor visceral manifestations. We report a case of lupus optic neuritis associated with anticardiolipin antibodies and a circulating lupus anticoagulant and suggest these may be a marker for vasculitic optic neuritis and play a role in its aetiology.

Optic neuritis and Jaccoud's syndrome in a patient with systemic lupus erythematosus

Unilateral optic neuritis and Jaccoud's Syndrome in a 34-year-old woman suffering from systemic lupus erythematosus is presented. We discuss the probable pathophysiological mechanisms of these two uncommon conditions. The most acceptable incriminating factor for optic neuritis is vasculitis.

Autoimmune retrobulbar optic neuritis

Three patients, all women, ranging in age from 26 to 44 years, had acute retrobulbar neuritis and laboratory evidence of a collagen vascular disorder. These patients were treated with intravenously administered "pulse" methylprednisolone, and visual acuity recovered in three of four involved eyes. Continued oral administration of prednisone and other immunosuppressive drugs was necessary to maintain vision.