Diagnosis of Optic Neuritis: Differentiation of Anti-aquaporin-4 Antibody-positive Optic Neuritis from Anti-aquaporin-4 Antibody-negative Optic Neuritis

Ueki Satoshi

doi:10.11476/shinkeiganka.34.267

This article describes a diagnosis method for optic neuritis confirmed by clinical observations and magnetic resonance imaging (MRI) abnormalities. Clinicians diagnose unilateral optic neuritis by clinical observations only. Unilateral optic nerve impairment is defined as 1) monocular decreased visual acuity not responsible for ocular media or monocular visual field defect with no defect in the other eye, 2) relative afferent pupillary defect positive. Important clinical observations of optic neuritis are disc swelling and ocular pain. If a patient does not have disc swelling, an assessment of relative afferent pupillary defect is necessary. Optic nerve enhancement by fat suppression gadolinium enhanced T1 weighted MRI confirms diagnosis of optic neuritis if other diseases impairing the blood-brain barrier, such as tumor, fungal infection, and radiation, are excluded. Patients with unilateral optic neuritis without autoantibodies meet the inclusion criteria for the Optic Neuritis Treatment Trial and Japanese trial conducted by the Optic Neuritis Treatment Trial Multicenter Cooperative Research Group. Almost all of these patients follow spontaneous recovery of visual function. However, if a patient does not display clinical characteristics revealed by the two treatment trials, clinicians should consider atypical optic neuritis. The most important differential diagnosis is anti-aquaporin-4 antibody-positive optic neuritis in neuromyelitis optica spectrum disorders.

Diagnosis of Optic Neuritis: Differentiation of Anti-aquaporin-4 Antibody-positive Optic Neuritis from Anti-aquaporin-4 Antibody-negative Optic Neuritis

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