FEATURES OF THE CLINICAL COURSE OF RETROBULBAR NEURITIS

В данной статье представлена особенности клинической картины ретробульбарного неврита вследствие рассеянного склероза. This article presents the features of the clinical picture of retrobulbar neuritis due to multiple sclerosis.

Retrobulbar neuritis associated with empty sella syndrome: A diagnostic challenge

A 35-year-old female presented with sudden diminution of vision to finger counting at half meters in right eye (RE) since 15 days. RE showed grade III RAPD. Rest of the ocular examination was normal. She had no significant past medical history. Neuroimaging showed empty sella. We suspected retrobulbar neuritis (RBN) as a cause of loss of vision since there was no evidence of acute change in morphology of sella turcica like hemorrhage, trauma or ischemia, furthermore there were no pathological findings in RE and visual cortex to explain acute visual loss. Therefore, we prescribed intravenous steroids followed by oral steroids. Vision in RE improved to 6/12 after 15 days. We found that RBN can be a cause of sudden vision loss in cases with empty sella syndrome (ESS) and can pose diagnostic challenge that whether the vision loss is due to ESS or RBN. RBN can be a cause of acute vision loss in patients with ESS and can create diagnostic confusion.

Clinic of ophthalmic lesions of the eye in multiple sclerosis

A literature review on the problem of multiple sclerosis (MS) with an emphasis on its ophthalmic manifestations is presented. This eye disorders are one of the most frequent early symptoms, along with unexplained weakness, absent-mindedness, memory impairment and other neurological complaints. The most common symptom of lesion is oculomotor disorders. Special attention is paid to such typical ophthalmic pathology of multiple sclerosis as optic (retrobulbar) neuritis. A number of features of the course of optic neuritis in multiple sclerosis are described, which help to establish the correct diagnosis. Key words: multiple sclerosis, ocular manifestations, optic (retrobulbar) neuritis.

The case of posterior ischemic optic neuropathy in patient with multiple sclerosis

A case of posterior ischemic optic neuropathy (PION) in a 41-year-woman with 19 years remission of multiple sclerosisis presented.She had complaints of acute unilateral loss of vision and underwent complex clinical and instrumental examination including B-scan of orbit, color duplex sonography (CDS) of orbital vessels and brachiocephalic arteries, magnetic resonance imaging (MRI). The significant stenosis of internal carotid artery due to its dissection was detected on the affected eye side. The results of ultrasound examinations and MRI excluded demyelinative retrobulbar neuritis (RBN) and determined the signs of blood flow impairment in vessels of orbital part of the optic nerve. Differential diagnostics of PION and RBN required the investigations of blood flow in orbital vessels and brachiocephalic arteries. Key words: posterior ischemic optic neuropathy, multiple sclerosis, retrobulbar neuritis, color duplex sonography, internal carotid artery.

Ophthalmological aspects of multiple sclerosis

The article presents a literature review on the issue of multiple sclerosis (MS) and its ophthalmological manifestations: etiopathogenesis, possible causes of development, peculiarities of the clinical picture, including the eyes, modern diagnostic capabilities and treatment approaches. Special attention is paid to such a typical for MS ophthalmopathology as optical (retrobulbar) neuritis. The authors present their own practical cases. Key words: multiple sclerosis, diagnosis, treatment, ocular manifestations, optical (retrobulbar) neuritis.

Unilateral hypopyon associated acute syphilitic posterior placoid chorioretinitis: Unusual presentation leading to HIV diagnosis

Syphilis has a wide variety of ocular presentations such as anterior or posterior uveitis, chorioretinitis, retinal vasculitis, retinitis, perineuritis, papillitis, retrobulbar neuritis, optic atrophy and optic nerve gumma. Therefore, it is recommended to test every patient with ocular inflammation for syphilis. It is, however, a relatively rare cause of uveitis in HIV disease. A few studies suggested that HIV contributes to the ocular manifestations of syphilis and HIV co-infection in approximately 30%. Acute syphilitic posterior placoid chorioretinopathy is a rare ocular manifestation in immune-competent patients characterised by the development of a deposit in the outer retina. We describe an unusual such presentation with hypopyon.

Determination of a specific marker of apoptosis in patients with retrobulbar neuritis against multiple sclerosis

Актуальность. Среди патологии зрительного нерва ретробульбарный неврит (РБН) встречается в 30-40% случаев. При этом в 45-80% случаев РБН первый признак рассеянного склероза (РС). Цель. Определить специфического маркера апоптоза у больных с РБН на фоне РС. Материал и методы. В исследование были включены 32 больных (52 глаза) РБН на фоне РС. Контрольную группу составили 10 соматически здоровых лиц. Уровень нейрон – специфической енолазы (NSE) в слезной жидкости (СЖ) и сыворотке крови (СК) определялся по методу иммуноферментного анализа на автоматическом электрохемилюминесцентном иммуноанализаторе Cobas e 411 для хемилюминесцентного иммуноанализа (Roche Diagnostics, Швейцария). Статистическая обработка данных выполнена с использованием программы Statistica-10.0. Результаты. Больные с РБН часто жаловались на резкое снижение остроты зрения (ОЗ) и снижение контрастности. По данным периметрии, на 24 глазах (46,2%) определялись относительные центральные скотомы. Изменения на глазном дне у больных были незначительными. Содержание NSE в СЖ было повышено по сравнению с контрольной группой (16,35±1,1) и составило в среднем 33,55±2,45нг/мл (р<0,01), хотя в сыворотке крови оно оставалось в пределах нормы (14,76±0,76). Это может быть связано с началом деструктивных процессов в нервной ткани и постепенной гибелью нейронов при нейродегенерации, с выходом NSE из поврежденных клеток во внеклеточную среду. Выводы. Регистрация уровня NSE помогает опосредованно делать предположения о тяжести заболевания и прогнозировать исход, так как клиническая картина и данные традиционных методов исследования не всегда отражают степень поражения зрительного нерва. Таким образом, наряду с клиническими признаками для оценки прогноза нарушений при РБН необходимо определение NSE в СЖ, как субклинического маркера нейродегенеративного процесса. Ее чувствительность составила 78%, специфичность – 72%.