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Orbital phlebography for differentiation between multiple sclerosis and venous vasculitis in subacute blindness
J Hannerz1, K Ericson, G Bergstrand
1Department of Neurology, Karolinska Sjukhuset, Stockholm, Sweden.
Acta Radiologica (Stockholm, Sweden : 1987)
|September 1, 1988
Summary
Subacute vision loss in patients without fundus pathology or elevated ESR may indicate multiple sclerosis or venous vasculitis. Orbital phlebography is key for diagnosis and guiding treatment, especially steroid therapy for venous vasculitis.
Area of Science:
- Ophthalmology
- Neurology
Background:
- Subacute unilateral vision loss with periorbital pain can present diagnostic challenges.
- Absence of fundus pathology and normal erythrocyte sedimentation rate (ESR) complicate initial assessments.
Purpose of the Study:
- To investigate the diagnostic utility of specific tests in patients with subacute unilateral vision loss and periorbital pain.
- To differentiate between multiple sclerosis and venous vasculitis in these patients.
- To evaluate treatment outcomes based on diagnosis.
Main Methods:
- Visual evoked response (VER)
- Electrophoresis of serum and cerebrospinal fluid (CSF)
- Orbital phlebography
Main Results:
- Seven of thirteen patients were diagnosed with multiple sclerosis (MS).
- Six patients were diagnosed with venous vasculitis.
- Spontaneous visual recovery occurred in all MS patients.
- Only two of six venous vasculitis patients regained vision, both treated with steroids within four days of symptom onset.
Conclusions:
- Orbital phlebography is the diagnostic procedure of choice for subacute vision loss.
- Early steroid treatment is crucial for visual recovery in venous vasculitis.
- Distinguishing MS from venous vasculitis is critical for appropriate patient management.