Recurrent optic neuritis

Posted by Dr. Raghavan Dr. Raghavan
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A 52 year old lady from North India came for an opinion here and was referred to me by a neurophysician. In short, she has had two episodes of bilateral simultaneous retrobulbar optic neuritis in the last six months and recovered with complete recovery after having been treated with usual treatment for optic neuritis.
Presently, she has no evidence of any ocular disability, Vision 6/6 & N6 in each eye with corrective glasses.Color vision normal with Isihara(20/20 plates) Pupils are normal, may be a tad not so brisk.Fundus normal. All investigations have been normal except delayed P 100 in both eyes in VEP. ACE inhibitor enzyme is raised but no other of sarcoidosis or any other infection.She is not on any drugs, maening no evidence of toxic amblyopia. MRI is normal with no white matter changes, absolutely no evidence of demyelination.CT chest was also normal. I had opined this as such must be left alone but in case of another recurrence, do all the tests to rule our AON-autoimmune optic neuritis, a skin biosy and a PET scan. It goes without saying she must be followed up for MS conversion
What say you?

3 Comments

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Dr. Thamburaj Dr. Thamburaj
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Re: Recurrent optic neuritis

I agree; this could be the beginning of MS.
I suggest u include CSF analysis for oligodendral bands and viral studies as well.
chakravarthi chakravarthi
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Re: Recurrent optic neuritis

In reply to this post by Dr. Raghavan
sir,
with the above data i can think of MS.
i have 4 patients with the same symptoms...
Dr Riaz Dr Riaz
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Re: Recurrent optic neuritis

In reply to this post by Dr. Raghavan
isolated ON need not be MS and some can continue to recur in Indian sub continet without established MS picture and with repeated shots of MP, tend to become better- worth following up with yearly MR- OCB in CSF is not that sensitive predictor at this time. By the way, how about pathergy test results??