526441 research-article2014
MSJ0010.1177/1352458514526441Multiple Sclerosis JournalCiampi
MULTIPLE SCLEROSIS MSJ JOURNAL
Clinical Commentary
Optic neuritis revealing Kikuchi–Fujimoto’s disease: clinical commentary
Multiple Sclerosis Journal 2014, Vol. 20(8) 1143–1144 © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1352458514526441 msj.sagepub.com
E Ciampi
Autoimmune optic neuropathies remain a diagnostic challenge. Both classification and diagnostic work-up consensus are still lacking. Differential diagnosis is relevant because of patient management and prognostic implications.1 Optic neuritis (ON) has been described as the initial manifestation of multiple sclerosis (MS) in about 20–30% of patients.2-4 Typical MS related ON factors include young, White adult with monocular, mildly painful (aggravated by eye movement), progressive (hours to days) visual loss (described as blurred vision) and dyschromatopsia. Pain is less common in anterior ON and lesions posterior to the orbit.5,6 The optic disc appears normal in about two-thirds of the affected eyes (retrobulbar ON), but varying degrees of swelling can be seen in the remainder. Visual field deficit is classically a central scotoma,7 but other defects can be found. Although the optic chiasm is a common site for MS plaques, only a few cases of bitemporal hemianopia have been published.8 Prognosis is typically good, recovery of vision is usually within the first few weeks of symptom onset, and it is influenced by the degree of initial visual loss.9 Atypical ON is referred to bilateral simultaneous or rapidly sequential onset, painless visual loss, severe pain or persisting longer than two weeks, severe visual loss (worse than 6/60), infrequent visual field loss, progression of visual loss for more than two weeks, lack of visual recovery starting within three weeks, severe optic disc swelling and evidence of orbital inflammation. Non-Caucasian, age at onset (>50 or
MSJ0010.1177/1352458514526441Multiple Sclerosis JournalCiampi
MULTIPLE SCLEROSIS MSJ JOURNAL
Clinical Commentary
Optic neuritis revealing Kikuchi–Fujimoto’s disease: clinical commentary
Multiple Sclerosis Journal 2014, Vol. 20(8) 1143–1144 © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1352458514526441 msj.sagepub.com
E Ciampi
Autoimmune optic neuropathies remain a diagnostic challenge. Both classification and diagnostic work-up consensus are still lacking. Differential diagnosis is relevant because of patient management and prognostic implications.1 Optic neuritis (ON) has been described as the initial manifestation of multiple sclerosis (MS) in about 20–30% of patients.2-4 Typical MS related ON factors include young, White adult with monocular, mildly painful (aggravated by eye movement), progressive (hours to days) visual loss (described as blurred vision) and dyschromatopsia. Pain is less common in anterior ON and lesions posterior to the orbit.5,6 The optic disc appears normal in about two-thirds of the affected eyes (retrobulbar ON), but varying degrees of swelling can be seen in the remainder. Visual field deficit is classically a central scotoma,7 but other defects can be found. Although the optic chiasm is a common site for MS plaques, only a few cases of bitemporal hemianopia have been published.8 Prognosis is typically good, recovery of vision is usually within the first few weeks of symptom onset, and it is influenced by the degree of initial visual loss.9 Atypical ON is referred to bilateral simultaneous or rapidly sequential onset, painless visual loss, severe pain or persisting longer than two weeks, severe visual loss (worse than 6/60), infrequent visual field loss, progression of visual loss for more than two weeks, lack of visual recovery starting within three weeks, severe optic disc swelling and evidence of orbital inflammation. Non-Caucasian, age at onset (>50 or
