Search

Objective: To investigate the clinical characteristics and prognosis of myelin oligodendrocyte glycoprotein (MOG) antibody-positive optic neuritis (ON). Methods: The data of 39 patients with MOG antibody-positive ON in the Department of Neurology of Beijing Tongren Hospital, Capital Medical University from January 1, 2017 to October 31, 2019 were retrospectively collected. There were 25 males and 14 females, aged from 15 to 80 (40±16) years. According to the recurrence, the patients were divided into two groups: the recurrence group ( n =12) and the non-recurrence group ( n =27). The clinical manifestations, relapse-related factors, magnetic resonance imaging (MRI) manifestations, treatment and prognosis of the two groups were analyzed. Results: A total of 63 eyes were involved, including 30 cases of optic perineuritis (OPN), accounting for 47.6% (30/63). The number of attacks ranged from 1 to 9, among which 12 patients had more than 2 attacks. There were 37 eyes [58.7% (37/63)] with severe visual loss (SVL) at the time of onset, and 7 eyes [11.1% (7/63)] with SVL at the final follow-up. Forty-eight eyes [76.2% (48/63)] had optic disc edema. Forty seven eyes [74.6% (47/63)] showed long-segment disease on optic nerve MRI. One case was complicated with aseptic meningitis and encephalitis. The recurrence group was younger than the non-recurrence group [(28.5±9.8) years vs (43.3±16.4) years, P =0.001]. There were no statistically significant differences between the two groups in gender, bilateral onset, initial visual acuity, final visual acuity, optic disc edema, head and spinal cord lesions, and immunosuppressant (all P >0.05). All patients were treated with methylprednisolone (MP) pulse therapy during the acute attack, and 16 of them were additively treated with immunosuppressive agents; the pain was alleviated or relieved significantly after the application of glucocorticoids. Conclusions: MOG antibody-positive ON often occurred in both eyes at the same time, often manifesting as OPN, often accompanied by optic disc edema, and SVL at the beginning of the disease, but most of the visual recovery was good, might be associated with meningitis and encephalitis. MRI of the optic nerve showed that the lesions often manifested as long-segment lesions. Glucocorticoids could alleviate pain and promote the recovery of visual function.

Objective: To investigate the clinical characteristics, treatment and prognosis of optic neuropathy associated with varicella zoster virus (VZV). Methods: Five cases of optic neuropathy associated with VZV infection from Department of Neurology between January 1, 2014 and March 31, 2019 were retrospectively collected. The clinical manifestations, treatment and prognosis were analyzed. Results: There were 7 eyes involved in 5 cases, 3 cases (3/5) involved only one eye, and 2 cases (2/5) involved both optic nerves. During the follow-up time, no recurrence was found. Severe visual impairment occurred in 4 eyes (4/7) and non-severe visual impairment in 3 eyes (3/7). Visual acuity improved significantly in 1 eye (1/7), turned better in 2 eyes (2/7), and remained unchanged in 4 eyes (4/7). In acute phase, abnormal signals of optic nerve and/or sheath were observed on MR images. Case 3 received antiviral and hormone therapy on the second day after the onset of the disease, and the visual acuity recovered well; the other 4 cases had poor prognosis. Conclusions: Head and face VZV infection can cause serious optic neuropathy, leading to severe visual dysfunction, and poor prognosis, but recurrence is rare. Early intravenous administration of antiviral drugs (acyclovir is the best) and hormones are recommended for VZV infection in this area. It is best to use drugs within 72 hours in order to avoid and reduce secondary optic neuropathy as far as possible.

Objective: To investigate the clinical features, imaging findings and prognosis of idiopathic intracranial hypertension (IIH) patients complicated with iron deficiency anemia (IDA). Methods: A total of 307 cases of IIH patients hospitalized in Beijing Tongren Hospital were retrospectively screened between January 1, 2011 and February 28, 2018. There were 49 anemia cases (15.96%) and 45 IDA cases (14.66%), respectively. Finally, 36 IDA patients were enrolled. The clinical characteristics, imaging findings, treatment and prognosis of these patients were analyzed. Results: IIH combined with IDA was more common in women of childbearing age (34/36). There were 30 obese and overweight cases (83.33%), with multiple subacute or chronic course of disease. The visual symptoms in the early IIH patients were first diagnosed in the Department of Ophthalmology. The first symptom was headache with/without visual symptoms (27 cases (75%)). Head MRI detected empty sella or partial empty sella, and 2 cases of venous sinus thrombosis were found in DSA examination. Of the 34 female patients, 24 had simple menometrorrhagia or menstrual disorder. All patients were given methyl acetate to reduce the intracranial pressure and iron therapy. Five patients received low molecular weight heparin-warfarin sequential treatment, 5 cases underwent gynecologic surgery and 2 male cases received hemorrhoid operation. There were 7 cases underwent lumbar cisterna-peritoneal shunt for visual impairment. During the follow-up, intracranial pressure decreased and visual function of patients improved significantly. Conclusions: IIH is frequently found in obese or overweight women at childbearing age and IDA may be an important cause of IIH. IIH can cause serious irreversible visual impairment. Therefore, early identification and active treatment should be performed. Correction of anemia can significantly improve the clinical symptoms of IIH. Operation should be employed for IIH patients with poor visual function or rapid progress, in order to reduce intracranial pressure and improve prognosis as soon as possible.

Objective: To summarize the clinical manifestation, treatment and prognosis of anterior ischemic optic neuropathy(AION) which was the manifestation of optic neuropathy related with Behcet's disease (BD). Methods: Retrospective series of case studies. The clinical data of 6 cases (9 eyes) of AION associated with BD who were hospitalized at the neurology ward of Beijing Tongren Hospital from February to June in 2016 were collected, the clinical characteristics of these patients were summarized, visual acuity were compared by using Wingerchuk visual grade before and after treatment. Results: Among the 6 patients with AION associated with BD, there were 4 males and 2 female, aged 38-60 years. All patients were acute onset, 3 cases had the onset of one eye, 2 cases with the onset of both eyes and 1 case with successively onset of both eyes. Optic nerve was damaged in 6 cases (9 eyes), only 1 case felt pain of eyes, the best corrected visual acuity of 4 eyes were less than 0.1, optic disk edema and linear bleeding around optic disk were oberved in all patients, the lower half visual field defect was the most common damage type (5 eyes), P100 latency of visual evoked potential prolonged in all patients, optic nerve MRI showed abnormal signal of optic nerve involvement in 2 patients. All patients were treated with corticosteroids and followed for 3 months, there was significant improvement in 1 eye of which the vision improved above 3 grade, and improvement in 6 eyes of which vision improved for 1-2 grade, while there has been no change in 2 eyes. Conclusions: BD may be the etiology of AION. Visual impairment of this kind of patients is relatively serious, visual function is expected to improve with early treatment. (Chin J Ophthalmol, 2019, 55:203-207) .

Objective: To compare the accuracy of electroencephalography (EEG) grading scale with amplitude-integrated electroencephalography (aEEG) in predicting poor outcomes (3-month), who sustained coma after cardiopulmonary resuscitation (CPR) in adults., Methods: A retrospective study was conducted. The patients with post-anoxic coma admitted to intensive care unit (ICU) of Tongren Hospital, Capital Medical University from March 2010 to June 2017 were enrolled. EEG was registered and recorded at least once within 7 days of coma after CPR, while not being subjected to therapeutic hypothermia. General data, Glasgow coma scale (GCS), EEG grading and aEEG model were collected. According to Glasgow prognosis score (GOS) of 3-month outcome, patients were divided into poor prognosis group (GOS 1-2) and good prognosis group (GOS 3-5), and the differences of related indexes between the two groups were compared. The predictive ability of aEEG model and EEG grading for brain function prognosis was evaluated by receiver operating characteristic (ROC) curve., Results: Fifty-four patients were included, with 31 males and 23 females, and age of (53.9±19.3) years. Among the EEG Young grades, 17 cases (31.5%) were grade 1, 4 cases (7.4%) were grade 2-5, and 33 cases (61.1%) were grade 6. Among the aEEG model grades, 26 cases (48.1%) had slow wave pattern grade 1, 23 cases (42.6%) had suppressed mode grade 4, 4 cases (7.4%) had status epilepticus mode grade 2, and 1 case (1.9%) had burst suppression mode grade 3. Thirty-six patients had poor prognosis 3-month after onset, 26 of them died and 10 had persistent vegetative state. The prognosis was good in 18 cases, including 16 cases with severe neurological disability and 2 cases with moderate neurological disability. There was no significant difference in gender, age, anoxic time between two groups with different prognosis, while the degree of consciousness disorder in poor prognosis group was more severe than that in good prognosis group (GCS score: 4.1±1.7 vs. 5.0±2.1, P < 0.05). The consistency test showed that different physicians had good consistency in EEG grading and aEEG model (Kappa values were 0.917 and 0.932, respectively). It was shown by ROC curve analysis that the area under ROC curve (AUC) of aEEG model and EEG grading for predicting poor prognosis of coma patients after CPR were 0.815 and 0.720, respectively (both P < 0.01); when the cut-off value of aEEG was 2.5, the sensitivity was 79.3%, the specificity was 77.4%, the positive likelihood ratios (PLR) was 3.508, and the negative likelihood ratios (NLR) was 0.267; when the cut-off value of EEG grading was 4.5, the sensitivity was 82.8%, the specificity was 61.3%, the PLR was 2.140, and NLR was 0.281., Conclusions: aEEG model was more accurate in prognosticating poor outcomes (3-month) in patients with post-anoxic coma, when compared to EEG grading. Its operation was simple, so aEEG is very suitable in ICU.

Objective: To explore the clinical characteristics and prognosis of chronic relapsing inflammatory optic neuropathy (CRION). Methods: A retrospective analysis was conducted. Clinical features, disease course, prognosis and magnetic resonance imaging (MRI) of patients with CRION who were admitted to Department of Neurology between 2014 and 2016 were reviewed and analyzed. Results: Totally, there were 27 patients (10 males and 17 females), with an age range of 17-59 years. The disease duration was between 40 days and 8 years. There were 2 to 9 CRION episodes. The mean frequency of CRION episodes was 3.30±1.56. The outcome of visual acuity showed that the more episodes frequency was, the worse outcome became. There was 25 abnormal optic nerve signals in MRI. And in 22 cases, the abnormal signals were in intraorbital segment or inner pipe section. The antinuclear antibodies (ANA) titers were elevated in 5 patients. Five cases relapsed during reduction or withdrawal of steroids, but steroids was not added in time. The final outcome of these 5 patients was poor. Conclusions: CRION was more common in female than male patients. Most patients were companied by pain, and the lesions were more common in the intraorbital segment of optic nerve. The more episode frequency was, the worse prognosis became. If a relapse happened, steroids or other immunosuppressive agents should be used.

Objective: To compare the clinical characteristics of Leber hereditary optic neuropathy (LHON) with optic neuritis (ON)., Methods: The information of clinical manifestation and laboratory tests in 55 patients with LHON and 48 patients with ON were reviewed and analyzed., Results: Compared with ON, LHON was more commonly found in male patients (46/55 vs 21/48) and onset at younger age (median 16 years vs 30 years). There were more LHON than ON patients with the decrease of visual acuity lasted more than two weeks (42/49 vs 10/48), severe damage in visual acuity whereas little pain sensation in eye associated with eye movement (3/55 vs 26/48), dominant single-phase course (53/55 vs 30/48), central scotoma (26/39 vs 12/35), and family history of maternal relatives (25/50 vs 2/48). The visual evoked potential, cerebral spinal fluid and brain magnetic resonance scanning revealed the involvement of inflammatory demyelination in the patients with LHON. Most patients with LHON could be confirmed by the mtDNA mutation examination., Conclusions: Leber hereditary optic neuropathy has distinct clinical characteristics but overlap with optic neuritis in many aspects. mtDNA mutation examination can further confirm LHON in most of patients although a negative result may be seen in a small portion of patients showing typical manifestation of LHON.

Objective: To investigate clinical characteristics of optic neuritis and its association with HLA (human leukocyte antigen)., Method: The clinical data of 42 patients with optic neuritis were collected and flow polymerase chain reaction-reverse sequence specific oligonucleotide probe (PCR-rSSOP) was used to determine the genotype of HLA-DRB1., Results: Two patients confirmed as Leber hereditary optic neuropathy by gene sequencing were excluded from the study. The complaint of pain was found in the patients (31/40) of optic neuritis. The visual field defect varied with patients and central and pericentral scotoma were demonstrated in 7 patients of 17. Of 40 patients with optic neuritis, 20 (50.0%) showed multifocal brain lesions in white matter by MR scanning. 26 of 38 patients had increased STIR signals. Inflammatory demyelinating changes were found in cerebral spinal fluid in 21 patients (80.8%). Out of demonstrated brain abnormal was revealed in 29 (72.5%) patients using MRI and/or CSF examination. The rate of HLA-DRB1(*)15 in the patients (35.0%) was much higher than control (19.4%), (chi(2) = 4.2328, P = 0.0397). Frequencies of HLA-DRB1(*)15 increased significantly in 26 female patients. The increased frequencies of HLA-DRB1(*)15 were associated with CSF abnormality and no relevancy was found with onset times, brain MR changes and increase of optic nerve signals. Acute optic neuritis responded well to intravenous megadose of methylprednisolone or immunoglobulin., Conclusions: Most of optic neuritis was characterized as clinical inflammatory demyelinating disease. HLA-DRB1(*)15 might correlated with genetic susceptibility of female patients with optic neuritis.