Zusammenfassung
Die akute Neuritis nervi optici ist eine klinische Diagnose und typischerweise durch
eine vor allem bei Augenbewegung schmerzhafte Sehminderung charakterisiert. Häufig
ist sie Ausdruck einer entzündlichen Systemerkrankung, insbesondere der Multiplen
Sklerose. Untypische Verläufe wie das beidseitige Auftreten, ein ungewöhnliches Erkrankungsalter
oder klinische Präsentation wie auch systemische und neurologische Begleitsymptome
erfordern differenzialdiagnostische Überlegungen. Neben der routinemäßigen neurologisch-klinischen
Untersuchung hat sich die MRT des Kopfes als Standarddiagnostik etabliert. Die Bildgebung
ermöglicht neben der Lumbalpunktion eine Aussage über das Multiple-Sklerose-Risiko.
Die Zusatzdiagnostik bei akuter Neuritis nervi optici hat in den letzten Jahren in
der Entscheidung über die immunmodulatorische Frühbehandlung des klinisch isolierten
Syndroms an Bedeutung gewonnen. Weitere serologische und bildgebende Untersuchungen
im Zusammenhang mit einer Neuritis nervi optici haben bei Verdacht auf eine infektiöse
Ursache, eine Sarkoidose oder systemische Autoimmunerkrankung ihren differenzialdiagnostischen
Stellenwert.
Abstract
The diagnosis of optic neuritis (ON) is made clinically based on typical signs and
symptoms such as reduced vision and painful eye movements. Very often, ON is part
of or associated with a systemic disease, in particular, multiple sclerosis (MS).
Differential diagnosis is necessary in untypical cases with bilateral involvement,
unusual age at manifestation or associated systemic and/or neurological symptoms.
Neurological examination and cerebral MRI are standard in ON work-up. CSF analysis
together with MRI scans allows MS risk assessment in ON patients. Further work-up
is necessary in suspected systemic autoimmune disorders, sarcoidosis or infectious
causes of ON such as borreliosis.
Schlüsselwörter
Neuroophthalmologie - Neuritis nervi optici - Multiple Sklerose
Key words
neuroophthalmology - optic neuritis - multiple sclerosis
Literatur
- 1
Gerling J, Janknecht P, Hansen L L et al.
Diameter of the optic nerve in idiopathic optic neuritis and in anterior ischemic
optic neuropathy.
Int Ophthalmol.
1997;
21
131-135
- 2
Stammen J, Unsold R, Arendt G et al.
Etiology and pathogenetic mechanisms of optic disc swelling with visual loss. An interdisciplinary
prospective pilot study of 102 cases.
Ophthalmologica.
1999;
213
40-47
- 3
Beck R W, Cleary P A, Trobe J D et al.
The effect of corticosteroids for acute optic neuritis on the subsequent development
of multiple sclerosis. The Optic Neuritis Study Group.
N Engl J Med.
1993;
329
1764-1769
- 4
Beck R W, Trobe J D, Moke P S et al.
High- and low-risk profiles for the development of multiple sclerosis within 10 years
after optic neuritis: experience of the optic neuritis treatment trial.
Arch Ophthalmol.
2003;
121
944-949
- 5
Optic Neuritis Study Group .
Multiple sclerosis risk after optic neuritis: final optic neuritis treatment trial
follow-up.
Arch Neurol.
2008;
65
727-732
- 6
Optic Neuritis Study Group .
The clinical profile of optic neuritis. Experience of the Optic Neuritis Treatment
Trial.
Arch Ophthalmol.
1991;
109
1673-1678
- 7
Rodriguez M, Siva A, Cross S A et al.
Optic neuritis: a population-based study in Olmsted County, Minnesota.
Neurology.
1995;
45
244-250
- 8
Jin Y P, Pedro-Cuesta de J, Soderstrom M et al.
Incidence of optic neuritis in Stockholm, Sweden, 1990 – 1995: II. Time and space
patterns.
Arch Neurol.
1999;
56
975-980
- 9
Jin Y P, Pedro-Cuesta de J, Soderstrom M et al.
Incidence of optic neuritis in Stockholm, Sweden 1990 – 1995: I. Age, sex, birth and
ethnic-group related patterns.
J Neurol Sci.
1998;
159
107-114
- 10
Schumacher G A, Beebe G, Kibler R F et al.
Problems of Experimental Trials of Therapy in Multiple Sclerosis: Report by the Panel
on the Evaluation of Experimental Trials of Therapy in Multiple Sclerosis.
Ann N Y Acad Sci.
1965;
122
552-568
- 11
McDonald W I, Compston A, Edan G et al.
Recommended diagnostic criteria for multiple sclerosis: guidelines from the International
Panel on the diagnosis of multiple sclerosis.
Ann Neurol.
2001;
50
121-127
- 12
Hickman S J, Dalton C M, Miller D H et al.
Management of acute optic neuritis.
Lancet.
2002;
360
1953-1962
- 13 Chan J W. Optic nerve disorders. New York: Springer; 2007: 1-129
- 14
Cleary P A, Beck R W, Bourque L B et al.
Visual symptoms after optic neuritis. Results from the Optic Neuritis Treatment Trial.
J Neuroophthalmol.
1997;
17
18-23
- 15 Wildberger H. Optikusneuritis. In Huber A, Kömpf D, eds Klinische Neuroophthalmologie..
Stuttgart, New York: Georg Thieme Verlag; 1998: 288-299
- 16
Slamovitis T L, Rosen C E, Cheng K P et al.
Visual recovery in patients with optic neuritis and visual loss to no light perception.
Am J Ophthalmol.
1991;
111
209-214
- 17
Silverman S E, Hart Jr W M, Gordon M O et al.
The dyschromatopsia of optic neuritis is determined in part by the foveal/perifoveal
distribution of visual field damage.
Invest Ophthalmol Vis Sci.
1990;
31
1895-1902
- 18
Flanagan P, Markulev C.
Spatio-temporal selectivity of loss of colour and luminance contrast sensitivity with
multiple sclerosis and optic neuritis.
Ophthalmic Physiol Opt.
2005;
25
57-65
- 19
Moura A L, Teixeira R A, Oiwa N N et al.
Chromatic discrimination losses in multiple sclerosis patients with and without optic
neuritis using the Cambridge Colour Test.
Vis Neurosci.
2008;
25
463-468
- 20
Kawasaki A, Purvin V A.
Idiopathic chiasmal neuritis: clinical features and prognosis.
Arch Ophthalmol.
2009;
127
76-81
- 21
Lightman S, McDonald W I, Bird A C et al.
Retinal venous sheathing in optic neuritis. Its significance for the pathogenesis
of multiple sclerosis.
Brain.
1987;
110 (Pt 2)
405-414
- 22
Compston A.
From the archives. Retinal venous sheating in optic neuritis. By S. Lightman et al.
Brain.
2010;
133
1573-1574
- 23
Lagreze W A.
Differentialdiagnose der Papillenschwellung.
Ophthalmologe.
2001;
98
417-431
- 24
Purvin V, Kawasaki A, Jacobson D M.
Optic perineuritis: clinical and radiographic features.
Arch Ophthalmol.
2001;
119
1299-1306
- 25 Brodsky M C. Pediatric Neuroophthalmology. New York: Springer; 2010 2 ed
- 26
Holder G E.
Electrophysiological assessment of optic nerve disease.
Eye.
2004;
18
1133-1143
- 27
Halliday A M, McDonald W I, Mushin J.
Visual evoked response in diagnosis of multiple sclerosis.
Br Med J.
1973;
4
661-664
- 28
Halliday A M, McDonald W I, Mushin J.
Delayed visual evoked response in optic neuritis.
Lancet.
1972;
1
982-985
- 29
Fisher J B, Jacobs D A, Markowitz C E et al.
Relation of visual function to retinal nerve fiber layer thickness in multiple sclerosis.
Ophthalmology.
2006;
113
324-332
- 30
Rejdak K, Jackson S, Giovannoni G.
Multiple sclerosis: a practical overview for clinicians.
Br Med Bull.
2010;
95
79-104
- 31
Henze T.
Symptomatische Therapie der Multiplen Sklerose.
Nervenarzt.
2004;
75 (Suppl 1)
2-39
- 32
Filippi M, Rocca M A.
Conventional MRI in multiple sclerosis.
J Neuroimaging.
2007;
17 (Suppl 1)
3S-9S
- 33
O’Riordan J I, Thompson A J, Kingsley D P et al.
The prognostic value of brain MRI in clinically isolated syndromes of the CNS. A 10-year
follow-up.
Brain.
1998;
121 (Pt 3)
495-503
- 34
Ormerod I E, Miller D H, McDonald W I et al.
The role of NMR imaging in the assessment of multiple sclerosis and isolated neurological
lesions. A quantitative study.
Brain.
1987;
110 (Pt 6)
1579-1616
- 35
Polman C H, Reingold S C, Edan G et al.
Diagnostic criteria for multiple sclerosis: 2005 revisions to the ”McDonald Criteria”.
Ann Neurol.
2005;
58
840-846
- 36
Sahraian M A, Eshaghi A.
Role of MRI in diagnosis and treatment of multiple sclerosis.
Clin Neurol Neurosurg.
2010;
112
609-615
- 37
Soderstrom M, Lindqvist M, Hillert J et al.
Optic neuritis: findings on MRI, CSF examination and HLA class II typing in 60 patients
and results of a short-term follow-up.
J Neurol.
1994;
241
391-397
- 38
Cole S R, Beck R W, Moke P S et al.
The predictive value of CSF oligoclonal banding for MS 5 years after optic neuritis.
Optic Neuritis Study Group.
Neurology.
1998;
51
885-887
- 39
Beck R W, Trobe J D.
What we have learned from the Optic Neuritis Treatment Trial.
Ophthalmology.
1995;
102
1504-1508
- 40
Jacobs L D, Beck R W, Simon J H et al.
Intramuscular interferon beta-1a therapy initiated during a first demyelinating event
in multiple sclerosis. CHAMPS Study Group.
N Engl J Med.
2000;
343
898-904
- 41
Filippi M, Rovaris M, Inglese M et al.
Interferon beta-1a for brain tissue loss in patients at presentation with syndromes
suggestive of multiple sclerosis: a randomised, double-blind, placebo-controlled trial.
Lancet.
2004;
364
1489-1496
- 42
Kappos L, Polman C H, Freedman M S et al.
Treatment with interferon beta-1b delays conversion to clinically definite and McDonald
MS in patients with clinically isolated syndromes.
Neurology.
2006;
67
1242-1249
- 43
Comi G, Martinelli V, Rodegher M et al.
Effect of glatiramer acetate on conversion to clinically definite multiple sclerosis
in patients with clinically isolated syndrome (PreCISe study): a randomised, double-blind,
placebo-controlled trial.
Lancet.
2009;
374
1503-1511
- 44
Linker R A, Kieseier B C.
Therapieentscheidungen bei Multipler Sklerose.
Nervenarzt.
2008;
79
1123-1124,1126 – 1128
- 45
Mandler R N, Davis L E, Jeffery D R et al.
Devic’s neuromyelitis optica: a clinicopathological study of 8 patients.
Ann Neurol.
1993;
34
162-168
- 46
Wingerchuk D M, Lennon V A, Pittock S J et al.
Revised diagnostic criteria for neuromyelitis optica.
Neurology.
2006;
66
1485-1489
- 47
Wingerchuk D M, Hogancamp W F, O’Brien P C et al.
The clinical course of neuromyelitis optica (Devic’s syndrome).
Neurology.
1999;
53
1107-1114
- 48
Zajicek J P, Scolding N J, Foster O et al.
Central nervous system sarcoidosis – diagnosis and management.
Qjm.
1999;
92
103-117
- 49
Koczman J J, Rouleau J, Gaunt M et al.
Neuro-ophthalmic sarcoidosis: the University of Iowa experience.
Semin Ophthalmol.
2008;
23
157-168
- 50
Pradella S P, Krause A, Muller A.
Akute Borreliainfektion. Einseitige Papillitis als isolierte klinische Manifestation.
Ophthalmologe.
1997;
94
591-594
- 51
Burkhard C, Gleichmann M, Wilhelm H.
Optic nerve lesion following neuroborreliosis: a case report.
Eur J Ophthalmol.
2001;
11
203-206
- 52
Mygland A, Ljostad U, Fingerle V et al.
EFNS guidelines on the diagnosis and management of European Lyme neuroborreliosis.
Eur J Neurol.
2010;
17
8-16, e11 – 14
- 53
Boomer J A, Siatkowski R M.
Optic neuritis in adults and children.
Semin Ophthalmol.
2003;
18
174-180
- 54
Selbst R G, Selhorst J B, Harbison J W et al.
Parainfectious optic neuritis. Report and review following varicella.
Arch Neurol.
1983;
40
347-350
- 55
Tauber T, Turetz J, Barash J et al.
Optic neuritis associated with etanercept therapy for juvenile arthritis.
J Aapos.
2006;
10
26-29
- 56
Zannin M E, Martini G, Buscain I et al.
Sudden visual loss in a child with juvenile idiopathic arthritis-related uveitis.
Br J Ophthalmol.
2009;
93
282-283, 417
- 57
Morales D S, Siatkowski R M, Howard C W et al.
Optic neuritis in children.
J Pediatr Ophthalmol Strabismus.
2000;
37
254-259
- 58
Deryck O, Ketelaer P, Dubois B.
Clinical characteristics and long term prognosis in early onset multiple sclerosis.
J Neurol.
2006;
253
720-723
- 59
Simone I L, Carrara D, Tortorella C et al.
Course and prognosis in early-onset MS: comparison with adult-onset forms.
Neurology.
2002;
59
1922-1928
- 60
Wilejto M, Shroff M, Buncic J R et al.
The clinical features, MRI findings, and outcome of optic neuritis in children.
Neurology.
2006;
67
258-262
- 61 Zettl U K, Köhler W, Buchmann J. Klinik der MS im Kinder- und Jugendalter. Stuttgart-
New York: Springer; 2007: 19-24
- 62
Absoud M, Cummins C, Desai N et al.
Childhood optic neuritis clinical features and outcome.
Arch Dis Child.
2010 Jun 16. [Epub ahead of print];
- 63
Bonhomme G R, Waldman A T, Balcer L J et al.
Pediatric optic neuritis: brain MRI abnormalities and risk of multiple sclerosis.
Neurology.
2009;
72
881-885
- 64
Shams P N, Plant G T.
Optic neuritis: a review.
Int MS J.
2009;
16
82-89
PD Dr. Christina Gerth-Kahlert
Augenklinik, Universität Rostock
Doberaner Straße 140
18055 Rostock
Telefon: ++ 49/3 81/4 94 85 55
Fax: ++ 49/3 81/4 94 85 01
eMail: chgerth@web.de
