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III. Ocular Neurology > Optic Neuritis (M1) > Flashcards

Optic Neuritis (M1) Flashcards

1
Q

What is the prognosis of MS?

A

many (50% at 10 yrs) have disability of not being able to walk without assistance

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2
Q

What is the type of multiple sclerosis that has a first episode of neurologic symptoms that lasts at least 24 hours and is caused by inflammation or demyelination (loss of the myelin that covers the nerve cells) in the central nervous system (CNS)?

A

Clinically isolated syndrome

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3
Q

What is the VF defect for typical optic neuritis typically characterized by? 1. Does it remain or resolve? 2

A
  1. central scotoma (but studies show all types)

2. resolve

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4
Q

What was the conclusion of the Controlled High Risk Avonex Multiple Sclerosis Study (CHAMPS)?

A

interferon beta (Avonex) had reduction in 3-year cumulative probability of developing clinically definite MS

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5
Q

What is characterized by transient neurologic dysfunction secondary to focal demyelination of the nervous system?

A

multiple sclerosis

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6
Q

According to the ONTT what does an IV steroid followed by an oral steroid do for the visual outcome? 1. Recurrence rate? 2. Development of MS? 3

A
  1. faster recovery but no long-term benefit
  2. same recurrence
  3. delayed
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7
Q

What type of optic neuritis is atypical optic neuritis associated with?

A

papillitis (nerve swelling, cotton wool spots, macular star)

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8
Q

What are the OCT findings in patients with a history of optic neuritis?

A

reduction in RNFL thickness

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9
Q

What is the most important predictor of future MS in previously unaffected patients with optic neuritis?

A

presence of lesions on MRI

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10
Q

What is the typical course of typical optic neuritis?

A
  1. VF defect that progresses, stabilizes after 14 days and then improves
  2. final VA of 20/40 (87%), 20/200 (8%). Still complain of vision not crisp
  3. residual deficits: color, brightness, contrast sensitivity, stereopsis, RAPD, optic disc pallor, latency of VEP
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11
Q

What is the most common disease course of MS?

A

Relapsing Remitting MS (RRMS)

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12
Q

What treatment should be considered for typical optic neuritis patients that have white matter lesions?

A

beta interferon

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13
Q

What are the most common symptoms of MS?

A
  1. weakness/numbness in limbs
  2. optic neuritis
  3. tremor and ataxic gait from cerebellar dysfunction
  4. double vision, dysarthia, or dizziness
  5. fatigue
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14
Q

What do most people that are initially diagnosed with RRMS transition to that is a progressive disease?

A

secondary-progressive MS (SPMS)

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15
Q

What is the epidemiology for typical optic neuritis?

A
  1. 15 to 50 yo
  2. female
  3. 85% caucasian
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16
Q

What type of MS is characterized by a steadily worsening neurologic function from the beginning?

A

primary progressive MS (PPMS)

17
Q

What are the signs of typical optic neuritis?

A
  1. acutely dec VA
  2. +RAPD
  3. dec color vision
  4. dec contrast sensitivity
  5. VF defect in most cases
18
Q

What must the physician do to diagnose MS, according to the McDonald criteria?

A
  1. Find evidence of damage in at least two separate areas of the central nervous system (CNS), which includes the brain, spinal cord and optic nerves AND
  2. Find evidence that the damage occurred at least one month apart AND
  3. Rule out all other possible diagnoses
19
Q

What are the steps taken in the evaluation and treatment of a typical optic neuritis?

A
  1. perform MRI
  2. normal MRI = no Tx; not normal = Tx (IV and oral steroids)
  3. follow pt over several weeks to check improvement
20
Q

What are the symptoms of typical optic neuritis?

A
  1. acute monocular visual loss
  2. pain around eye 1 week before or after visual problems. Worse with eye movement
  3. flashes of light o showers of sparks
  4. Uhthoff’s phenomenon (blur when hot)
21
Q

According to the ONTT what does an oral steroid do for the visual outcome? 1. Recurrence rate? 2

A
  1. no benefit

2. increase recurrance

22
Q

What type of optic neuritis is typical optic neuritis associated with?

A

retrobulbar = accompanies demyelinating disease

23
Q

What are the ophthalmoscopic findings of typical optic neuritis?

A
  1. normal (retrobulbar) =65%
  2. swollen nerve head (blurred disc margins, papillitis) = 35%
  3. no macular star
  4. nerve head pallor = 10%
24
Q

What are the abnormalities in the fellow eye of typical unilateral optic neuritis (with percentage of people that have this)?

A
  1. dec VA (14%)
  2. contrast sensitivity (15%)
  3. color vision (21%)
  4. VF (48%)

III. Ocular Neurology (17 decks)

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