Optic neuritis: Difference between revisions
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==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
===Age=== | === Incidence === | ||
=== | * The incidence/prevalence of [disease name] is approximately [number range] per 100,000 individuals worldwide. | ||
=== | * In [year], the incidence/prevalence of [disease name] was estimated to be [number range] cases per 100,000 individuals worldwide. | ||
=== Prevalence === | |||
* The incidence/prevalence of [disease name] is approximately [number range] per 100,000 individuals worldwide. | |||
* In [year], the incidence/prevalence of [disease name] was estimated to be [number range] cases per 100,000 individuals worldwide. | |||
* The prevalence of [disease/malignancy] is estimated to be [number] cases annually. | |||
=== Age === | |||
* Patients of all age groups may develop [disease name]. | |||
* The incidence of [disease name] increases with age; the median age at diagnosis is [#] years. | |||
* [Disease name] commonly affects individuals younger than/older than [number of years] years of age. | |||
* [Chronic disease name] is usually first diagnosed among [age group]. | |||
* [Acute disease name] commonly affects [age group]. | |||
=== Race === | |||
* There is no racial predilection to [disease name]. | |||
* [Disease name] usually affects individuals of the [race 1] race. [Race 2] individuals are less likely to develop [disease name]. | |||
=== Gender === | |||
* [Disease name] affects men and women equally. | |||
* [Gender 1] are more commonly affected by [disease name] than [gender 2]. The [gender 1] to [gender 2] ratio is approximately [number > 1] to 1. | |||
==Risk Factors== | ==Risk Factors== | ||
Revision as of 18:37, 9 November 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]
Overview
Historical Perspective
Discovery
- Optic neuritis was first discovered by von Graefe and Nettleship, in late nineteenth century when ophthalmoscopy became part of the ophthalmic examination.[1]
- The association between systemic sclerosis and optic neuritis was made by the early 1900's but there was much controversy and misunderstanding about its differential diagnosis, pathogenesis, and possible treatment.[1]
- Optic neuritis was first distinguished from infectious,hereditary, toxic, nutritional, and ischemic optic neuropathies during the twentieth century.[1]
- During late twentieth century, the development of MRI and the results from recent clinical trials, discovered the relationship between optic neuritis and multiple sclerosis.[1]
Classification
Optic neuritis may be classified into atypical or typical subtypes based on its clinical features.[2]
- Atypical optic neuritis entails clinical manifestations that deviate from classic pattern of optic neuritis features.[3]
- Atypical features to consider include:[3]
- Lack of pain
- Simultaneous or near-simultaneous onset
- Lack of response to or relapse upon tapering from corticosteroids
- Optic neuritis due nerve head or peripapillary hemorrhages
Pathophysiology
Pathogenesis
- The exact pathogenesis of optic neuritis is not completely understood.[4][5]
- But It is likely due to some inflammatory process which leads to delayed type IV hypersensitivity reaction induced by released cytokines and other inflammatory mediators from activated peripheral T-cells which can cross the blood brain barrier and cause destruction of myelin, neural cell death and axonal degeneration.[4][5]
- In addition to involvement of the myelin sheath (white matter), latest technologies such as optical coherence tomography (OCT) suggest involvement of axons (gray matter) in this process.[4][5]
- Findings suggestive of optic neuritis in microscopic histopathological analysis include:[6]
- Reduced axon counts
- Optic atrophy
- Inflammation
- Demyelination
- Axonal loss
- Intracellular neurofilaments
Causes
- The exact cause of optic neuritis is unknown.[7][8][9]
- But It is likely due invasion of the immune system to the myelin, resulting in inflammation and damage to the myelin.
The following autoimmune are associated with optic neuritis:[7][8][9]
- Multiple sclerosis:
- Multiple sclerosis is the first main cause of optic neuritis.[8]
- 50% of patients with multiple sclerosis finally develop optic neuritis.[9]
- Neuromyelitis optica
- In Neuromyelitis optica, inflammation recurs in the optic nerve and spinal cord.
- Infections:
Differentiating Optic Neuritis from other Diseases
Optic neuritis must be differentiated from other diseases that cause sudden eye pain and vision loss such as:[2]
- Leber’s Hereditary Optic Neuropathy (LHON)[2] which results from point mutations in mitochondrial DNA and subsequent mitochondrial dysfunction, causing bilateral central vision loss.[10]
- Nonarteritic Anterior Ischemic Optic Neuropathy (AION)[2]
- It is the most common form of ischemic optic neuropathy and the second most common optic neuropathy.
- It is more common in patients over the age of 50 years with vasculopathic risk factors such as:
Epidemiology and Demographics
Incidence
- The incidence/prevalence of [disease name] is approximately [number range] per 100,000 individuals worldwide.
- In [year], the incidence/prevalence of [disease name] was estimated to be [number range] cases per 100,000 individuals worldwide.
Prevalence
- The incidence/prevalence of [disease name] is approximately [number range] per 100,000 individuals worldwide.
- In [year], the incidence/prevalence of [disease name] was estimated to be [number range] cases per 100,000 individuals worldwide.
- The prevalence of [disease/malignancy] is estimated to be [number] cases annually.
Age
- Patients of all age groups may develop [disease name].
- The incidence of [disease name] increases with age; the median age at diagnosis is [#] years.
- [Disease name] commonly affects individuals younger than/older than [number of years] years of age.
- [Chronic disease name] is usually first diagnosed among [age group].
- [Acute disease name] commonly affects [age group].
Race
- There is no racial predilection to [disease name].
- [Disease name] usually affects individuals of the [race 1] race. [Race 2] individuals are less likely to develop [disease name].
Gender
- [Disease name] affects men and women equally.
- [Gender 1] are more commonly affected by [disease name] than [gender 2]. The [gender 1] to [gender 2] ratio is approximately [number > 1] to 1.
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Criteria
Symptoms
Physical Examination
Laboratory Findings
Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Prevention
References
- ↑ 1.0 1.1 1.2 1.3 Volpe NJ (December 2001). "Optic neuritis: historical aspects". J Neuroophthalmol. 21 (4): 302–9. PMID 11756864.
- ↑ 2.0 2.1 2.2 2.3 Kliethermes MA (July 1988). "Working parents in two-pharmacist marriages". Am J Hosp Pharm. 45 (7): 1500. PMID 3414716.
- ↑ 3.0 3.1 Gaier ED, Boudreault K, Rizzo JF, Falardeau J, Cestari DM (December 2015). "Atypical Optic Neuritis". Curr Neurol Neurosci Rep. 15 (12): 76. doi:10.1007/s11910-015-0598-1. PMID 26467052.
- ↑ 4.0 4.1 4.2 Hoorbakht H, Bagherkashi F (2012). "Optic neuritis, its differential diagnosis and management". Open Ophthalmol J. 6: 65–72. doi:10.2174/1874364101206010065. PMC 3414716. PMID 22888383.
- ↑ 5.0 5.1 5.2 Toosy AT, Mason DF, Miller DH (January 2014). "Optic neuritis". Lancet Neurol. 13 (1): 83–99. doi:10.1016/S1474-4422(13)70259-X. PMID 24331795.
- ↑ Taniguchi S, Kawano T, Kakunaga T, Baba T (May 1986). "Differences in expression of a variant actin between low and high metastatic B16 melanoma". J. Biol. Chem. 261 (13): 6100–6. PMID 3700386.
- ↑ 7.0 7.1 Marechal F, Berthiot G, Deltour G (1988). "Serum levels of CA-50, CA-19.9, CA-125, CA-15.3, enolase and carcino-embryonic antigen in non neoplastic diseases of the lung". Anticancer Res. 8 (4): 677–80. PMID 3178158.
- ↑ 8.0 8.1 8.2 Bourdial J (April 1969). "[Otorhinolaryngologic action in asthmatics]". Maroc Med (in French). 49 (523): 209–17. PMID 5398737.
- ↑ 9.0 9.1 9.2 Balcer LJ (March 2006). "Clinical practice. Optic neuritis". N. Engl. J. Med. 354 (12): 1273–80. doi:10.1056/NEJMcp053247. PMID 16554529.
- ↑ Fujimori H (December 1973). "[Pulmonary tuberculosis--keypoints in nursing of pregnant and puerperal patients]". Josanpu Zasshi (in Japanese). 27 (12): 40–3. PMID 4492634.