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Importance Visual impairment in primary central nervous system lymphoma (PCNSL) is caused mostly by intraocular lymphomatous involvement (vitritis and retinal infiltration), whereas optic nerve infiltration (ONI) is a rare condition. Objective To describe the clinical presentation of ONI, its imaging characteristics, and outcome. Design, Setting and Participants A total of 752 patients diagnosed with PCNSL were retrospectively identified from the databases of 3 French hospitals from January 1, 1998, through December 31, 2014. Of these, 7 patients had documented ONI. Exclusion criteria were intraocular involvement, orbital lymphoma, or other systemic lymphoma. Clinical presentation, neuroimaging, biological features, treatment, and outcomes were assessed. Main Outcomes and Measures Treatment response was evaluated clinically and radiologically on follow-up magnetic resonance imaging (MRI) according to the International PCNSL Collaborative Group response criteria. Results The 7 patients included 5 women and 2 men. Median age at diagnosis was 65 years (range, 49-78 years). Two patients had initial ONI at diagnosis, and 5 had ONI at relapse. Clinical presentation was marked by rapidly progressive and severe visual impairment for all patients. The MRI findings showed optic nerve enlargement in 3 patients and contrast enhancement of the optic nerve in all patients. Additional CNS lesions were seen in 4 patients. Examination of cerebrospinal fluid samples detected lymphomatous meningitis in 2 patients. Clinical outcome was poor and marked by partial recovery for 2 patients and persistent severe low visual acuity or blindness for 5 patients. Median progression-free survival after optic nerve infiltration was 11 months (95% CI, 9-13 months), and median overall survival was 18 months (95% CI, 9-27 months). Conclusions and Relevance Optic nerve infiltration is an atypical and challenging presentation of PCNSL. Its visual and systemic prognosis is particularly poor compared with vitreoretinal lymphomas even in response to chemotherapy. Although intraocular involvement is frequent in PCNSL and clinically marked by slowly progressive visual deterioration, lymphomatous ONI is rare and characterized by rapidly progressive severe visual impairment.

Resume Introduction Les meningiomes sont des tumeurs meningees primitives benignes. Leur decouverte peut etre fortuite ou secondaire a l’exploration de symptomes neurologiques, voire ophtalmologiques. Patients et methodes Nous rapportons les histoires cliniques et paracliniques de cinq patientes ayant presente des symptomes ophtalmologiques qui ont conduit au diagnostic de meningiomes. Resultats Il s’agissait de cinq femmes, âgees de 52 ans en moyenne au moment du debut des symptomes. Elles presentaient toutes une baisse de l’acuite visuelle unilaterale progressive avec un fond d’œil initialement normal, associee a une alteration du champ visuel ipsilateral. Les differents examens complementaires et notamment radiologiques ont du etre repetes pour mener au diagnostic de meningiome dans un delai allant de 18 mois a quatre ans. Discussion Le tableau clinique de ces cinq cas est celui d’une neuropathie optique retrobulbaire ayant oriente le bilan vers la recherche d’une maladie inflammatoire du systeme nerveux central. Mais le caractere atypique de la neuropathie a fait reconsiderer le diagnostic et repeter les examens d’imagerie. Le caractere iso-intense des meningiomes en T1 et peu hyperintense en T2 en imagerie par resonance magnetique (IRM) peut conduire a un retard diagnostique et therapeutique si l’examen n’est pas fait et interprete par un professionnel experimente. L’injection de Gadolinium, les sequences avec suppression de graisse et le centrage sur les voies optiques anterieures sont des elements indispensables lors de l’IRM. Conclusion Devant une neuropathie optique indolore, d’evolution progressive, et resistante a la corticotherapie, le diagnostic de meningiome des voies optiques anterieures doit etre envisage. Celui-ci est facilite par une IRM adaptee aux voies optiques.

Resume Introduction Les paralysies oculomotrices dans la sclerose en plaques (SEP) sont caracterisees par une ophtalmoplegie internucleaire ou un deficit isole de l’abduction ou de l’adduction. Une paralysie complete unilaterale ou un syndrome « un et demi » de Fischer sont plus rares. Une ophtalmoplegie horizontale bilaterale a ete rapportee de facon exceptionnelle. Observation Nous decrivons ici un cas d’ophtalmoplegie horizontale bilaterale dans le cadre d’un premier evenement demyelinisant a haut risque de SEP. L’examen de l’IRM cerebrale retrouvait une lesion inflammatoire des deux noyaux abducens dans la partie mediane du tegmentum pontique expliquant la semiologie oculomotrice. Une recuperation complete apres 3 g de solumedrol intraveineux a ete observee. Discussion Seuls deux cas comme celui-ci ont ete precedemment decrits dans la litterature, tous associes a une paralysie faciale peripherique dans le cadre d’un premier evenement de SEP. Notre patiente a la particularite de presenter une atteinte oculomotrice sans autre lesion du tronc associee. Par analogie avec le syndrome « un et demi » de Fisher, cette ophtalmoplegie horizontale complete bilaterale tres rare pourrait etre intitulee syndrome « un plus un » et pourrait correspondre de facon specifique a un premier evenement demyelinisant de SEP.

Resume But Le but de l’etude realisee etait de quantifier les accidents oculaires graves lies a l’utilisation d’artifice de divertissement (ADD) en Alsace, de preciser les caracteristiques epidemiologiques de la population victime et d’evaluer le recours a la chirurgie et a l’hospitalisation en urgence, le type de lesions oculaires et le pronostic visuel a long terme. Patients et methodes Nous avons realise une etude retrospective des dossiers des patients hospitalises de janvier 1994 a janvier 2007 aux hopitaux universitaires de Strasbourg pour blessure oculaire grave liee a l’utilisation d’ADD. Resultats Nous avons recense 39 accidents oculaires. Ces blessures oculaires touchaient les hommes jeunes (95 % d’hommes ; âge moyen : 19,38 ans). Les lesions etaient des contusions dans 61,5 % des cas, des brulures dans 33,3 % des cas, des plaies perforantes du globe oculaire dans 15,4 % des cas. Plus de la moitie des patients presentaient des blessures oculaires ayant necessite un recours a une prise en charge chirurgicale en urgence. L’hospitalisation totale induite etait de 259 jours. L’acuite visuelle finale etait abaissee dans 33,3 % des cas et 25,6 % des patients ont presente une perte fonctionnelle oculaire majeure (acuite visuelle inferieure a 1/20). Conclusion Les feux d’artifice sont une cause de baisse d’acuite visuelle, en particulier chez les hommes jeunes. Tous les ans de nouveaux accidents se produisent lors des fetes de la nouvelle annee qui sont des exceptions faites dans la legislation locale sur la vente et l’usage des ADD. Le strict encadrement legal de l’usage des ADD et l’information du public pourrait peut-etre eviter la perte fonctionnelle de plusieurs yeux chaque annee.

Introduction La diplopie est une complication connue du traitement chirurgical du decollement de retine par cryo-indentation. Pathologie de la binocularite, elle survient en general en raison de troubles de la motilite oculaire. Patients et methodes Nous avons mene une etude retrospective des patients ayant ete traites par cryo-indentation pour un decollement de retine aux Hopitaux Universitaires de Strasbourg entre 1988 et 2006. Les caracteristiques des patients, le type d’explant, les complications immediates et tardives ont ete relevees. Resultats Sur 821 patients operes de decollement de retine par cryo-indentation, 12 ont presente une diplopie binoculaire persistante (superieure a 3 mois) dont 7 verticales, 2 horizontales et 3 obliques. L’examen des 12 patients a montre 7 hypertropies pures, 3 hypertropies associees (a une esotropie ou une exotropie chez 2 et 1 patients respectivement) et 2 exotropies. L’ablation de l’explant a ete proposee en premiere intention a tous les patients, permettant une recuperation fonctionnelle pour 6 d’entre eux. Secondairement, 3 patients ont pu etre soulages de leur diplopie par un prisme. Un traitement chirurgical entrainant le sevrage du prisme pour la vision de loin a ete realise chez les 3 derniers patients. Discussion La diplopie compliquant la chirurgie du decollement de retine par cryo-indentation repond, dans notre etude, a un traitement simple dans la majorite des cas. L’ablation de l’explant permet de soulager la gene dans la moitie des cas ; une prismation est utile pour les patients non soulages par l’explantation. Le traitement chirurgical est souvent efficace. Conclusion Pathologie de la vision binoculaire, la diplopie survenant dans les suites d’un traitement chirurgical d’un decollement de la retine repond en general a un traitement simple permettant de lever un deficit fonctionnel handicapant au quotidien.

Background: Neuromyelitis optica (NMO) is an inflammatory disease associated with optic neuritis and myelitis. Recently, several studies showed that optical coherence tomography (OCT) could be an interesting method for the evaluation of disease severity; however, to date there are no studies with a longitudinal follow-up of visual function in NMO. The aim of this study was to assess the ability of OCT to evaluate the progression of visual dysfunction in NMO. Patients and methods: A group of 30 NMO patients (thus, 60 eyes), comprised of 20 women and 10 men with a mean age of 43.7 +/− 12.3 years, were prospectively evaluated clinically and by a whole neuro-ophthalmological work-up, including: visual acuity (VA), fundoscopy, visual evoked potential (VEP), visual field (VF) and optical coherence tomography (OCT). All patients were tested at baseline (after a mean disease duration of 6.1 years) and after a mean time of follow-up of 18 months (range: 12–36 months). Results: Mean VA was similar at the two evaluation times (0.77 +/− 0.36 versus 0.77 +/− 0.35). The mean VF defect decreased slightly, but the difference was not significant (−5.9 +/− 1.3 dB versus −5.3 +/− 1.3 dB). In contrast, the mean retinal thickness seen on OCT decreased from 87.4 +/− 23.3 µm to 79.7 +/- 22.4 µm ( p = 0.006). These modifications were only observed in eyes with a past or a recent history of optic neuritis (−15.1 µm; p < 0.001) and not in eyes without any history of optic neuritis (−2.4 µm; not significant). Also, they occurred independently of the occurrence of relapses ( n = 13) and especially optic neuritis episodes; however, the number of optic neuritis episodes was low ( n = 5). Conclusion: OCT seems to be a more sensitive test than VA or VF for monitoring ophthalmological function in NMO and it seems to be helpful for the detection of infra-clinical episodes in patients with a past history of optic neuritis. Our results suggest that this easily performed technique should be used in the follow-up of NMO, but complementary studies are warranted to confirm its interest at an individual level.

Oculomotor deficiencies in multiple sclerosis (MS) are frequently characterized by internuclear ophthalmpoplegia or isolated abduction or adduction palsies. Complete unilateral conjugate gaze paralysis and the "one and a half" syndrome are rare. Complete bilateral horizontal gaze paralysis has been exceptionally reported.Here, we describe an unusual oculomotor paralysis as a suspected first event of MS. A 24-year-old woman with an uneventful medical history presented for sudden onset of binocular diplopia. On examination, abduction and adduction saccades were impossible, whereas vertical eye saccades and convergence were normal. Oculocephalic reflex failed to improve horizontal eye movement. No nystagmus and no other sign of brainstem dysfunction were observed. Visual acuity was 4/10 in the right eye and 6/10 in the left eye. A sign of Marcus Gunn was noted in the right eye. Blood samples and cerebrospinal fluid were normal, no oligoclonal bands were detected. Visual evoked potentials were significantly impaired in both eyes and argued for bilateral optic neuritis. Brain MRI scans showed white matter T2-hypersignal abnormalities, which fulfill Barkhof criteria for MS. A small symmetric lesion was noted in the posterior part of the medial pontine tegmentum. As a first episode of MS was suspected, treatment with methylprednisolone 1000 mg/d for 3 days was started, and was followed by complete recovery of eye movements and visual acuity after 3 weeks.To our knowledge, only two cases of complete horizontal bilateral ophthalmoplegia have been reported in the literature. Both were associated with peripheral facial nerve palsy as a first event in MS. In our case report, we describe for the first time a complete bilateral horizontal ophthalmoplegia with no other brainstem dysfunction. By analogy with the "one and a half" syndrome, such complete horizontal gaze paralysis could be named a "one and one" syndrome and seems to be specifically related to a first event of MS.

The purpose of the study was to review cases of serious fireworks-related eye injuries presented in the Strasbourg (France) University Hospital ophthalmology emergency department and to analyze epidemiological and clinical data such as visual outcomes and risk factors.A 13-year retrospective study (1994-2007) including fireworks-related ocular and adnexal injuries requiring hospitalization was conducted.Thirty-nine patients were reported; 95% were male. The mean age was 19.38 years old. There was 61.5% contusions, 33.3% eye and adnexal burns, and 15.4% of the patients suffered from a penetrating injury. More than half of the patients required emergency ophthalmic surgical procedures. Twenty-six percent of the patients had final visual acuity of 20/400 or less.Fireworks are a cause of severe eye injury in France. These injuries are potentially preventable, especially in young males.

Meningiomas are benign primary meningeal tumors. Their diagnosis may be incidental or in response to a work-up for neurological or ophthalmological symptoms.The clinical course of five patients with ophthalmological symptoms leading to the diagnosis of meningioma is described.The case reports consist of five women (48 to 54 years old - mean 52 years at the onset of symptoms), all suffering from a progressive unilateral decrease in visual acuity with a normal initial fundus examination and ipsilateral visual field changes. Ancillary testing, in particular MRI and CT-scans, had to be repeated to make the diagnosis of meningioma, which was delayed from 18 months to 4 years.The clinical presentation of these five cases was that of a retrobulbar optic neuropathy, which biased the work-up towards an inflammatory disease of the central nervous system such as multiple sclerosis. However, the atypical character of the neuropathy, which did not respond to intravenous steroids, caused the diagnosis to be questioned and radiological examinations repeated. The iso-intense appearance of meningiomas on T1 MR imaging and only slightly hyperintense appearance on T2 may result in a diagnostic delay if the exam is not performed and interpreted by an experienced professional. Gadolinium contrast, fat suppression and centration on the anterior visual pathways are essential to a proper MRI examination.When confronted with a progressive, painless optic neuropathy unresponsive to steroid treatment, the diagnosis of meningioma of the anterior visual pathways must be considered. This diagnosis is enabled by a targeted MRI of the anterior visual pathways.

Neuromyelitis optica (NMO) is an inflammatory disease with combined features of optic neuritis and myelitis. This pathologic entity may induce severe disability, including visual loss and paraplegia. Other than clinical follow-up, there is no marker for severity of the disease.To evaluate the use of optical coherence tomography (OCT) in NMO and to determine whether this new technique could be a good marker of axonal loss in NMO.Cross-sectional study.Thirty-five patients with NMO or at a high risk for NMO (having optic neuritis or myelitis and who are positive for NMO antibody) were prospectively studied. Fifteen healthy individuals served as control subjects.All patients underwent a complete ophthalmologic evaluation, including OCT, funduscopy, and visual field, visual acuity, and visual evoked potential testing. Expanded Disability Status Scale scores were assessed but without the visual data. Correlations between the visual test results and demographic or clinical characteristics were evaluated.Optical coherence tomography and visual field data were available for only 32 patients because 3 patients were blind. The mean retinal nerve fiber layer thickness was significantly reduced in patients with NMO compared with controls (P.001). We found good correlation between the OCT results and visual field testing. We also found weak correlation between OCT results and both visual acuity and visual evoked potential latencies. We did not find any correlation between OCT results and age, sex, or disease duration. In contrast, retinal nerve fiber layer thickness was closely correlated with the Expanded Disability Status Scale score (P.001).Optical coherence tomography results are significantly altered in patients with NMO. Optical coherence tomography is easy to perform, and the results are well correlated with visual acuity and visual field findings. It could be considered a marker of axonal loss because we found good correlation between OCT and the Expanded Disability Status Scale score. These preliminary results will need to be confirmed in a longitudinal prospective study.

Diplopia is a well-known complication of scleral buckling for retinal detachment. It is generally caused by ocular motility disturbances.We conducted a retrospective study on patients operated on for retinal detachment between 1998 and 2006 at Strasbourg University Hospital (France) who secondarily complained of diplopia. Patient history, scleral buckling type, and early and late postoperative complications were described.Among 821 patients who underwent scleral buckling, 12 developed diplopia lasting more than 3 months. Six of the scleral buckling operations were vertical, three horizontal, and three oblique. Examination of the 12 patients showed seven cases of hypertropia, two cases of hypertropia associated with esotropia, one case of hypertropia with exotropia, and two cases of exotropia. The scleral buckle was removed in first intention in all 12 patients; binocular single vision was restored in six cases. Secondarily, prism correction restored binocular vision in three additional patients. Strabismus surgery was necessary for the remaining three patients.Diplopia following retinal detachment usually responds to simple measures. In our study, the removal of the buckle restored binocular vision in the majority of cases, a prism correction was useful for the remaining patients. Strabismus surgery was often very efficient.Diplopia complicating scleral buckling generally responds to simple treatments that can eliminate a handicapping functional deficit.

BACKGROUND: Visual impairment in Primary CNS lymphoma (PCNSL) in most of the cases is due to an intraocular lymphomatous involvement, especially uveitis. Optic nerve infiltration (ONI) in PCNSL is a rare condition. We sought to describe its clinical presentation, imaging characteristics, and outcomes. METHODS: Patients with ONI of PCNSL were retrospectively identified from 1998 to 2014 from the databases of the university hospitals Pitie-Salpetriere (Paris) and Rene Huguenin (Saint-Cloud), and the academic teaching hospital Pasteur (Colmar), France. Exclusion criteria were intraocular involvement, orbital lymphoma, or other systemic lymphoma. Clinical presentation, neuroimaging, biological features, treatment and outcomes were assessed from their medical records. RESULTS: Only 6 of 710 PCNSL were identified as presenting ONI. Patients' median age at presentation was 65 years (49-78), 5 were women. 2 patients had ONI at initial diagnosis, 3 at 1st relapse after HD-MTX based chemotherapy, and 1 at 2nd relapse after HD-MTX, salvage chemotherapy and high-dose chemotherapy with autologous stem cell transplant. Clinical presentation: Rapidly progressive visual impairment without red eyes (6/6 patients), painless (4/6), unilateral (4/6), bilateral (2/6), bilateral hemianopia (2/6). MRI: Optic nerve swelling (3/6), contrast-enhancement of the entire ON (5/6) or of the ON sheath (1/6); Localization of ONI: Chiasmic (3/6), cisternal (3/6), intracanalicular (3/6), and intraorbital (4/6). Additional CNS lesions were seen in 4/6. Systemic lymphoma was excluded in all patients; lumbar puncture was done in 4/6 proving leptomeningeal disease in 2. Median delay from symptom onset to treatment: 25 days (10-140). Treatment: Different chemotherapy regimens were administered but lymphoma recurred in the majority. Clinical outcome: Partial recovery (2/6 patients), persisting low vision or blindness (4/6). Radiological outcome: Complete remission (4/6), partial remission (1/6), stable disease (1/6). Median PFS after ONI: 11 months (3-11), OS: 32 months (12-40). CONCLUSIONS: Intraocular involvement is observed in about 15% of PCNSL, clinically marked by slowly progressive visual deterioration over several months, usually caused by posterior uveitis. Lymphomatous infiltration of the optic nerve is characterized by a rapidly progressive severe visual impairment. In patients with ONI as initial presentation of PCNSL, it is difficult to establish the diagnoses as differential diagnosis are broad. In these patients, optic nerve biopsy should be discussed only in absence of cerebral lesions. At relapse, clinical presentation, neuroimaging and the absence of intraocular involvement may help to establish the diagnosis. As optic nerve functional outcome is poor, rapid treatment might improve clinical outcome. ACKNOWLEDGEMENTS: LOC national network (INCa).

Subacute loss of vision accompanied by pain is most commonly due to some form of inflammatory optic neuropathy (ON), and may be the first symptom of multiple sclerosis (MS). ON may also be due to viral or bacterial infection or systemic diseases. Although ON is frequently limited to a single episode, some patients experience recurrent episodes. The name recently given to these recurrent episodes of inflammatory ON with a negative workup for MS or other causes of ON is relapsing inflammatory ON (RION).1 MRI scans are normal and oligoclonal bands are rarely found in the CSF. Some patients with an initial diagnosis of RION are, after several years of follow-up, diagnosed with neuromyelitis optica (NMO), due to the occurrence of one or more episodes of myelitis.2 Recently, a specific marker of NMO, named NMO antibody, was found.3 There is now evidence to suggest that patients who experience recurrent episodes of myelitis and are positive for NMO antibodies are at a high risk of developing NMO.4 A similar hypothesis could be applied to RION. In the first study on NMO antibodies, a positive result was found in 2 of 8 patients with RION.3 However, the …

Introduction Parmi les tumeurs de la surface oculaire, les neoplasies intra-epitheliales corneennes (CIN) sont une entite rare, moins frequente que les carcinomas epidermoides et les carcinomes in situ de la conjonctive. Nous rapportons le cas d’un patient presentant une CIN. Materiels et Methodes Il s’agissait d’un homme, âge de 35 ans, d’origine Nord Africaine et sans antecedents notables, nous ayant ete refere pour une lesion corneenne atypique de l’œil gauche, lentement progressive et entrainant une baisse d’acuite visuelle a 7/10e. La lesion etait circulaire, plane, epitheliale, en forme de « C » autour de l’axe optique et prenait la fluoresceine. Le patient rapportait qu’il avait deja ete opere, plusieurs annees auparavant, d’une lesion corneenne de ce meme œil mais sans examen anatomopathologique. Resultats Nous avons pratique une resection chirurgicale de l’epithelium atteint suivi de la mise en place d’une lentille therapeutique. L’analyse anatomopathologique a mis en evidence la presence d’une neoplasie corneenne intra-epitheliale. Un traitement adjuvant par collyre a la Mitomycine C 0,04 % a raison de 4 gouttes par jour a ete debute en post operatoire afin de prevenir l’apparition d’une nouvelle recidive. 6 mois apres l’intervention, le patient ne presentait aucun signe de recidive et son acuite visuelle etait de 10/10e P2. Discussion Les neoplasies intra-epitheliales corneennes n’ont pas de potentiel metastatique et leur principal risque est la recidive locale. La resection chirurgicale permet de guerir les patients et la chimiotherapie locale post operatoire previent le risque de recidive. Trois types d’agents peuvent etre utilises en collyre : la Mitomycine C, l’interferon alpha 2-beta ou le 5-fluorouracile. Les principaux effets secondaires de la Mitomycine C en instillation sont la reaction allergique et la stenose du point lacrymal. Conclusion La neoplasie corneenne est une tumeur rare de la surface oculaire ne mettant pas en jeu le pronostic vital. Le traitement comporte un temps chirurgical suivi d’une chimiotherapie locale.

But Estimer l’incidence des blessures oculaires graves liees a l’utilisation d’artifices de divertissement a Strasbourg. Preciser le type de lesions oculaires et les caracteristiques epidemiologiques de la population atteinte. Objectifs et Methodes Etude retrospective sur 13 ans incluant les patients hospitalises aux hopitaux universitaires de Strasbourg pour blessure oculaire liee a l’utilisation de petards. Les criteres d’etude : sexe, âge, type de lesion, acuite visuelle initiale et finale et prise en charge initiale. Resultats Le nombre total de patients etait de 35. L’âge moyen etait de 19,9 ans. Les patients etaient de sexe masculin dans 93,4 % des cas. Les contusions oculaires representaient 21 cas, les brulures 13 cas, les plaies du globe 5 cas. L’acuite visuelle initiale etait inferieure a 1/20 chez 23 patients. Une prise en charge chirurgicale initiale a ete necessaire dans 54 % des cas. La duree moyenne de l’hospitalisation initiale etait de 4,9 jours. L’acuite visuelle a 3 mois etait inferieure a 1/10 dans 34 % des cas et chiffrable a 10/10 dans 60 % des cas. Discussion Les exceptions de la reglementation sur la vente et l’utilisation des artifices de divertissement dans le Bas-Rhin correspondent a des pics de frequence des blessures par artifices. Conclusion L’utilisation des artifices de divertissement est a l’origine d’environ 3 blessures oculaires severes par an a Strasbourg. Celles-ci touchent preferentiellement l’homme jeune et peuvent etre accessibles a des mesures preventives.

Introduction Les meningiomes sont des tumeurs meningees primitives benignes. Leur decouverte peut etre fortuite ou secondaire a l’exploration de symptomes neurologiques voire opthalmologiques. Observations Nous rapportons les histoires cliniques et paracliniques de cinq patientes presentant des symptomes ophtalmologiques et conduisant au diagnostic de meningiomes. Il s’agissait de cinq femmes, âgees de 49 a 55 ans au moment du debut des symptomes. Elles presentaient toutes une baisse de l’acuite visuelle unilaterale progressive avec un fond d’œil initialement normal, associee a une alteration du champ visuel ipsilateral. Le tableau clinique de ces cinq cas etait celui d’une neuropathie optique retro bulbaire orientant le bilan vers la recherche d’une affection demyelinisante du systeme nerveux central. Les differents examens complementaires et notamment radiologiques durent etre repetes pour mener au diagnostic de meningiome dans un delai allant de 18 mois a 4 ans. Discussion Le caractere isointense des meningiomes en T1 et peu hyperintense en T2 en imagerie par resonance magnetique peut faire meconnaitre le diagnostic et retarder la prise en charge therapeutique si l’examen n’est pas interprete par un professsionnel experimente. L’injection de Gadolinium montrant un rehaussement de la lesion facilite le diagnostic. Conclusion L’imagerie joue un role primordial pour le diagnostic de meningiome. L’injection de Gadolinium et le centrage des coupes sur les voies optiques en cas de symptomes opthalmologiques sont absolument necessaires.

Background Optical coherence tomography has emerged as a new tool for quantifying axonal loss in multiple sclerosis (MS). A reduction in retinal nerve fiber layer (RNFL) thickness is correlated with Expanded Disability Status Scale score and brain atrophy. Objective To investigate RNFL and macular volume measurements using optical coherence tomography in the clinically isolated syndrome population. Design Prospective case series. Settings Neurologic clinics at the university hospitals of Lille and Strasbourg (France). Participants Fifty-six consecutive patients with clinically isolated syndrome (18 with optic neuritis and 38 without optic neuritis) and 32 control subjects. Main Outcome Measures Macular volume and RNFL thickness. Results Mean (SD) overall RNFL thickness (98.98 [10.26] μm) and macular volume (6.86 [0.32] μm 3 ) in the clinically isolated syndrome population were not significantly different compared with the controls (98.71 [9.08] μm and 6.92 [0.38] μm 3 , respectively). No link was noted between atrophy of the RNFL or macula and conversion to MS at 6 months. Conclusions Optical coherence tomography does not reveal retinal axonal loss at the earliest clinical stage of MS and does not predict conversion to MS at 6 months.