Optic neuritis - Revision history

Ostermayer: /* Management */

2022-11-09T13:53:25Z

Management

← Revisión anterior		Revisión del 13:53 9 nov 2022
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	==Management==		==Management==
	*Consult neuro and ophthalmology with treatment focused on the underlying [[MS]]		*Consult neuro and ophthalmology with treatment focused on the underlying [[Multiple_sclerosis#Management\|MS]]
	*IV [[methylprednisolone]], 1 g QD x3 days<ref>Le Page, E. et al. Oral versus intravenous high-dose methylprednisolone for treatment of relapses in patients with multiple sclerosis (COPOUSEP): a randomised, controlled, double-blind, non-inferiority trial. Lancet. 2016 Jan 23;387(10016):340.</ref>		*IV [[methylprednisolone]], 1 g QD x3 days<ref>Le Page, E. et al. Oral versus intravenous high-dose methylprednisolone for treatment of relapses in patients with multiple sclerosis (COPOUSEP): a randomised, controlled, double-blind, non-inferiority trial. Lancet. 2016 Jan 23;387(10016):340.</ref>

Ostermayer: /* Management */

2022-11-09T13:50:44Z

Management

← Revisión anterior		Revisión del 13:50 9 nov 2022
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	==Management==		==Management==
	*Consult neuro and ophthalmology		*Consult neuro and ophthalmology with treatment focused on the underlying [[MS]]
	*IV [[methylprednisolone]], 1 g QD x3 days		*IV [[methylprednisolone]], 1 g QD x3 days<ref>Le Page, E. et al. Oral versus intravenous high-dose methylprednisolone for treatment of relapses in patients with multiple sclerosis (COPOUSEP): a randomised, controlled, double-blind, non-inferiority trial. Lancet. 2016 Jan 23;387(10016):340.</ref>

	==Disposition==		==Disposition==

Rossdonaldson1: /* Evaluation */

2022-02-05T13:06:50Z

Evaluation

← Revisión anterior		Revisión del 13:06 5 feb 2022
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	==Evaluation==		==Evaluation==
	[[File:PMC3379920 jovr-5-3-216-776-1-pbf1.png\|thumb\|MRI showing enhancement of the left optic nerve, which is typical of optic neuritis.]]		[[File:PMC3379920 jovr-5-3-216-776-1-pbf1.png\|thumb\|MRI showing enhancement of the left optic nerve, which is typical of optic neuritis.]]
	===Physical Exam===		===Diagnosis on Physical Exam===
	*Red desaturation test		*Red desaturation test
	**Have patient look with one eye at a dark red object		**Have patient look with one eye at a dark red object

Rossdonaldson1 at 10:42, 5 February 2022

2022-02-05T10:42:54Z

← Revisión anterior		Revisión del 10:42 5 feb 2022
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	**Plus angioconverting enzyme, IgG indices, myelin basic protein, oligoclonal bands		**Plus angioconverting enzyme, IgG indices, myelin basic protein, oligoclonal bands
	**Plus SERUM IgG indices, oligoclonal bands, angioconverting enzyme, NMO antibodies		**Plus SERUM IgG indices, oligoclonal bands, angioconverting enzyme, NMO antibodies

			==Management==
			*Consult neuro and ophthalmology
			*IV [[methylprednisolone]], 1 g QD x3 days

	==Disposition==		==Disposition==
	*~~Consult neuro and ophthalmology~~		*Admission
	*Inpatient admission for IV methylprednisolone, 1 g QD x3 days

	==See Also==		==See Also==

Elcatracho: /* Causes */

2021-03-14T22:15:32Z

Causes

← Revisión anterior		Revisión del 22:15 14 mar 2021
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	**[[meningitis\|Meninges]], [[orbital cellulitis\|orbit]], [[sinusitis\|sinuses]]		**[[meningitis\|Meninges]], [[orbital cellulitis\|orbit]], [[sinusitis\|sinuses]]
	*Other infections		*Other infections
	**[[Syphilis]], [[Tuberculosis]], ~~Crypto~~		**[[Syphilis]], [[Tuberculosis]], [[Cryptococcus]]
	*[[Sarcoidosis]], uveitis		*[[Sarcoidosis]], uveitis
	*[[Temporal arteritis]]		*[[Temporal arteritis]]

Rossdonaldson1: /* Evaluation */

2020-12-16T21:16:06Z

Evaluation

← Revisión anterior		Revisión del 21:16 16 dic 2020
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	==Evaluation==		==Evaluation==
	[[File:PMC3379920 jovr-5-3-216-776-1-pbf1.png\|thumb\|MRI showing enhancement of the left optic nerve ~~(arrow)~~ which is typical of optic neuritis.]]		[[File:PMC3379920 jovr-5-3-216-776-1-pbf1.png\|thumb\|MRI showing enhancement of the left optic nerve, which is typical of optic neuritis.]]
	===Physical Exam===		===Physical Exam===
	*Red desaturation test		*Red desaturation test

Rossdonaldson1: /* Evaluation */

2020-12-16T21:15:42Z

Evaluation

← Revisión anterior		Revisión del 21:15 16 dic 2020
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	==Evaluation==		==Evaluation==
			[[File:PMC3379920 jovr-5-3-216-776-1-pbf1.png\|thumb\|MRI showing enhancement of the left optic nerve (arrow) which is typical of optic neuritis.]]
	===Physical Exam===		===Physical Exam===
	*Red desaturation test		*Red desaturation test

Rossdonaldson1: /* Background */

2020-12-16T21:02:45Z

Background

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	==Background==		==Background==
			[[File:Schematic diagram of the human eye en.png\|thumb\|Eye anatomy.]]
	*Inflammatory, demyelinating condition of the optic nerve highly associated with MS		*Inflammatory, demyelinating condition of the optic nerve highly associated with MS
	**50% will go on to develop MS		**50% will go on to develop MS

NadavNahumi: /* Background */

2020-03-28T23:28:58Z

Background

← Revisión anterior		Revisión del 23:28 28 mar 2020
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	*Female and Caucasian predominance		*Female and Caucasian predominance
	*Age 20-50 years old		*Age 20-50 years old
			*More prevalent in populations located at higher latitudes

	===Causes===		===Causes===

ClaireLewis at 04:22, 3 October 2019

2019-10-03T04:22:56Z

← Revisión anterior		Revisión del 04:22 3 oct 2019
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	**[[Measles]], [[mumps]], [[varicella zoster virus]], [[EBV]]		**[[Measles]], [[mumps]], [[varicella zoster virus]], [[EBV]]
	*Inflammation of structures contiguous with the optic nerve		*Inflammation of structures contiguous with the optic nerve
	**Meninges, orbit, sinuses		**[[meningitis\|Meninges]], [[orbital cellulitis\|orbit]], [[sinusitis\|sinuses]]
	*Other infections		*Other infections
	**[[Syphilis]], [[Tuberculosis]], Crypto		**[[Syphilis]], [[Tuberculosis]], Crypto
	*[[Sarcoidosis]], uveitis		*[[Sarcoidosis]], uveitis
	*[[Temporal arteritis]]		*[[Temporal arteritis]]
	*Vasculitides		*[[vasculitis\|Vasculitides]]
	*Ischemic optic neuropathy		*Ischemic optic neuropathy
	*Hypertensive retinopathy, papilledema		*Hypertensive retinopathy, [[papilledema]]
	*[[Diabetes mellitus]] retinopathy		*[[Diabetes mellitus]] retinopathy
	*[[Intracranial tumor]], orbital tumor		*[[Intracranial tumor]], orbital tumor
	*Glaucoma		*[[Glaucoma]]

	==Clinical Features==		==Clinical Features==
	*Acute, usually monocular, vision loss occurring over days (occasionally over hours)		*Acute, usually monocular, [[vision loss]] occurring over days (occasionally over hours)
	**May range from mildly reduced to no light perception whatsoever		**May range from mildly reduced to no light perception whatsoever
	*Retro-orbital headache		*Retro-orbital [[headache]]
	*Pain (esp with eye movement)		*[[eye pain\|Pain]] (esp with eye movement)
	*Loss of color vision out of proportion to loss of visual acuity		*Loss of color vision out of proportion to loss of visual acuity
	*Pulfrich effect - swing object side to side like pendulum, but patient feels like the object is coming at them in elliptical fashion; suggestive of demyelination<ref>O'Doherty M and Flitcroft DI. An unusual presentation of optic neuritis and the Pulfrich phenomenon. J Neurol Neurosurg Psychiatry. 2007 Aug; 78(8): 906–907.</ref>		*Pulfrich effect - swing object side to side like pendulum, but patient feels like the object is coming at them in elliptical fashion; suggestive of demyelination<ref>O'Doherty M and Flitcroft DI. An unusual presentation of optic neuritis and the Pulfrich phenomenon. J Neurol Neurosurg Psychiatry. 2007 Aug; 78(8): 906–907.</ref>
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	**Test the other eye to see if the object looks the same color		**Test the other eye to see if the object looks the same color
	***Affected eye often will see the red object as pink or lighter red		***Affected eye often will see the red object as pink or lighter red
	*Normal intraocular ~~pressures~~		*Normal [[intraocular pressure]]s
	*Normal slit lamp exam (no evidence of uveitis)		*Normal slit lamp exam (no evidence of uveitis)
	*Afferent ~~Pupilary~~ Defect (APD)		*Afferent Pupillary Defect (APD)
	*Optic disc swelling and edema (papillitis)		*Optic disc swelling and edema (papillitis)
	**Elevated optic nerve disk on [[ultrasound]] = papilledema		**Elevated optic nerve disk on [[ocular ultrasound]] = papilledema
	**Increased ON sheath diameter > ~5mm measured 3mm behind globe on US<ref>Shevlin C. Optic Nerve Sheath Ultrasound for the Bedside Diagnosis of Intracranial Hypertension: Pitfalls and Potential. http://www.criticalcarehorizons.com/optic-nerve-sheath-diameter-icp/</ref>		**Increased ON sheath diameter > ~5mm measured 3mm behind globe on US<ref>Shevlin C. Optic Nerve Sheath Ultrasound for the Bedside Diagnosis of Intracranial Hypertension: Pitfalls and Potential. http://www.criticalcarehorizons.com/optic-nerve-sheath-diameter-icp/</ref>