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Variation in Evolving Optic Neuritis.

Marc A Bouffard1, Robert M Mallery, Yaping J Liao

  • 1Department of Neurology, Beth Israel Deaconess Medical Center (MAB), Harvard Medical School, Boston, Massachusetts; Department of Surgery, Division of Ophthalmology (NT), Harvard Medical School, Boston, Massachusetts; Department of Neurology (RMM), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and Department of Ophthalmology (YJL), Byers Eye Institute, Stanford University, Palo Alto, California.

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|July 26, 2021
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Summary
This summary is machine-generated.

Exceptions to the typical progression of optic neuritis, particularly concerning pain and vision loss duration, offer insights into diverse causes. Recognizing these atypical presentations aids in diagnosing challenging cases of optic neuritis.

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Area of Science:

  • Neuro-ophthalmology
  • Neurology

Background:

  • The natural history of optic neuritis typically involves recovery, with exceptions like chronic relapsing inflammatory optic neuropathy.
  • Exceptions in the evolving phase of optic neuritis are less understood.
  • Recognizing atypical presentations can reveal specific etiologies.

Purpose of the Study:

  • To describe atypical courses of evolving optic neuritis.
  • To highlight clinical heterogeneity in optic neuritis evolution.
  • To aid in earlier recognition of diagnostically challenging cases.

Main Methods:

  • Retrospective review of medical records of patients with atypical optic neuritis.
  • Analysis of cases treated by the study authors.

Main Results:

  • Four patients with atypical incipient optic neuritis were identified.
  • Diagnoses included idiopathic optic neuritis, neuromyelitis optica spectrum disease, anti-myelin oligodendrocyte glycoprotein antibody disease, and multiple sclerosis.
  • Key atypical features included unusual timing of pain onset, prolonged pain duration, and extended worsening of optic neuropathy.

Conclusions:

  • Optic neuritis exhibits significant clinical heterogeneity in its evolution.
  • Variability exists in the timing of pain, pain duration, and the period of worsening neuropathy.
  • Attention to these exceptions can improve the diagnosis of complex optic neuritis cases.