Questions:
1. What is the typical visual field defect in nonarteritic PION?
2. Is disc swelling usually seen with nonarteritic PION?
3. What does PION not associated with surgery in patients older than age 50 generally indicate?
4. What should be ruled-out in non-operative PION in patients under 50?
1
Question:
Which of the following statements are correct?
1. Anterior ischemic optic neuropathies are considered the equivalent of a “stroke of the optic nerve”.
2. The causes and mechanisms of anterior ischemic optic neuropathies and stroke are different.
3. The workup of a patient with an ischemic optic neuropathy is not the same as that for patients with retinal or cerebral infarction.
4. The clinician’s primary role in ischemic optic neuropathies is to exclude giant cell arteritis, control vascular risk factors, treat anemia, and prevent hypotension (e.g., in the setting of dialysis).
5. Anterior ischemic optic neuropathies are not associated with ipsilateral internal carotid artery stenosis and embolic AION is extremely rare.
6. Medications, such as amiodarone, may induce an optic neuropathy often indistinguishable from AION.
1
Questions:
1. What is the most common optic neuropathy in patients over age 50?
2. Why are altitudinal visual field defects common in ischemic optic neuropathies?
3. Do emboli commonly cause ischemic optic neuropathy?
1
Questions:
1. What are the ophthalmoscopic characteristics of neuroretinitis?
2. Is neuroretinitis caused by demyelination?
3. In what settings does neuroretinitis most commonly occur?
1
Questions:
1. When inflammatory optic neuritis is not associated with a primary demyelinating process in the optic nerve or the central nervous system what is the likely cause?
2. When inflammatory optic neuritis is not associated with a primary demyelinating process in the optic nerve or the central nervous system what should drive the work-up?
3. Is optic neuritis common in secondary and tertiary syphilis?
4. How is syphilitic optic neuritis treated and what is its prognosis?
5. What should be done all patients with HIV and optic neuritis?
1
Questions:
1. Is ADEM more common in in children or adults?
2. What may the clinical symptoms and MRI changes of ADEM mimic?
3. How many symptomatic episodes of ADEM is a patient likely to experience?
4. Is optic neuritis seen in some patients with ADEM?
1
Question: When should an ophthalmologist consider the diagnosis of a paraneoplastic syndrome?
2
Question with answers: When should an ophthalmologist consider the diagnosis of a paraneoplastic syndrome?
“In terms of afferent symptoms, an unexplained, painless, progressive vision loss is typical. With retinal involvement, there may be photopsias, night blindness, or ring scotomas. In the optic neuropathies, there is most commonly bilateral disc swelling often accompanied by vitritis. Efferent symptoms include myasthenic-like presentation or the presence of opsoclonus/myoclonus syndrome (OMS).”1
Questions:
1. Does the Transverse myelopathy of Neuromyelitis Optica (NMO) precede or follow the onset of optic neuritis?
2. Is there an antibody test for NMO?
3. What is the prognosis for NMO?
4. What are the diagnostic criteria for NMO?
3
John H. Stone, M.D., M.P.H., Katie Tuckwell, Ph.D., Sophie Dimonaco, M.Sc., Micki Klearman, M.D., Martin Aringer, M.D., Daniel Blockmans, M.D., Ph.D., Elisabeth Brouwer, M.D., Ph.D., Maria C. Cid, M.D., Bhaskar Dasgupta, M.B., B.S., M.D., Juergen Rech, M.D., Carlo Salvarani, M.D., Georg Schett, M.D., Hendrik Schulze-Koops, M.D., Ph.D., Robert Spiera, M.D., Sebastian H. Unizony, M.D., and Neil Collinson, Ph.D.
N Engl J Med 2017; 377:317-328July 27, 2017DOI: 10.1056/NEJMoa1613849
BACKGROUND
Giant-cell arteritis commonly relapses when glucocorticoids are tapered, and the prolonged use of glucocorticoids is associated with side effects. The effect of the interleukin-6 receptor alpha inhibitor tocilizumab on the rates of relapse during glucocorticoid tapering was studied in patients with giant-cell arteritis.
METHODS
In this 1-year trial, we randomly assigned 251 patients, in a 2:1:1:1 ratio, to receive subcutaneous tocilizumab (at a dose of 162 mg) weekly or every other week, combined with a 26-week prednisone taper, or placebo combined with a prednisone taper over a period of either 26 weeks or 52 weeks. The primary outcome was the rate of sustained glucocorticoid-free remission at week 52 in each tocilizumab group as compared with the rate in the placebo group that underwent the 26-week prednisone taper. The key secondary outcome was the rate of remission in each tocilizumab group as compared with the placebo group that underwent the 52-week prednisone taper. Dosing of prednisone and safety were also assessed.
RESULTS
Sustained remission at week 52 occurred in 56% of the patients treated with tocilizumab weekly and in 53% of those treated with tocilizumab every other week, as compared with 14% of those in the placebo group that underwent the 26-week prednisone taper and 18% of those in the placebo group that underwent the 52-week prednisone taper (P<0.001 for the comparisons of either active treatment with placebo). The cumulative median prednisone dose over the 52-week period was 1862 mg in each tocilizumab group, as compared with 3296 mg in the placebo group that underwent the 26-week taper (P<0.001 for both comparisons) and 3818 mg in the placebo group that underwent the 52-week taper (P<0.001 for both comparisons). Serious adverse events occurred in 15% of the patients in the group that received tocilizumab weekly, 14% of those in the group that received tocilizumab every other week, 22% of those in the placebo group that underwent the 26-week taper, and 25% of those in the placebo group that underwent the 52-week taper. Anterior ischemic optic neuropathy developed in one patient in the group that received tocilizumab every other week.
CONCLUSIONS
Tocilizumab, received weekly or every other week, combined with a 26-week prednisone taper was superior to either 26-week or 52-week prednisone tapering plus placebo with regard to sustained glucocorticoid-free remission in patients with giant-cell arteritis. Longer follow-up is necessary to determine the durability of remission and safety of tocilizumab. (Funded by F. Hoffmann–La Roche; ClinicalTrials.gov number, NCT01791153.)
Full article available at http://sfx.stanford.edu/local?sid=Entrez:PubMed&id=pmid:28745999 SuNet ID and Password required.
Questions:
1. What is the most common acute optic neuropathy in persons under the age of 45?
2. What is the most common cause of optic neuritis?
3. What condition is a common presenting sign of multiple sclerosis?
