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but the pupil is said never to be dilated in ambient light If the optic neuritis is unilateral, the consensual light re ex from the normal eye is retained (Demyelination of the third nerve in its brainstem course, however, may be associated with a xed enlargement of the pupil) As noted in Chap 13, about half of patients with optic neuritis recover completely, and most of the remaining ones improve signi cantly, even those who present initially with profound visual loss and, later, pallor of the optic disc (Slamovitis et al) Any pain in the globe is short-lived and persistent pain should prompt an evaluation for local disease In a cohort of 397 patients enrolled in the Optic Neuritis Treatment Trial and examined 5 years after the initial attack of optic neuritis, visual acuity had returned to 20/25 or better in 87 percent of patients and to 20/40 or better in 94 percent even if there had been a recurrence of optic neuritis during the 5-year period Moreover, the mode of treatment did not appear to in uence the outcome Dyschromatopsia, generally taking the form of a perceived desaturation of colors, frequently persists When improvement occurs, it usually begins within 2 weeks of onset, as is true of most acute manifestations of MS, perhaps sooner with corticosteroid treatment Once improvement in neurologic function begins, it may continue for several months The main point to be made here is that one-half or more of adult patients who present with optic neuritis will eventually develop other signs of MS The prospective investigation of Rizzo and Lessell showed that MS developed in 74 percent of women and 34 percent of men by the 15th year after onset of visual loss; similar results were reported by the Optic Neuritis Study Group (Beck and associates 2003) The risk is much lower if the initial attack of optic neuritis occurs in childhood [26 percent developed after 40 years of follow-up; Lucchinetti et al (1997)]; this suggests that some instances of the childhood disease may be of a different type, perhaps viral or postinfectious Of more practical value is the observation, in the later study by Beck and colleagues, that the risk is also considerably lower (22 percent at 10 years) if the cranial MRI fails to reveal demyelinative lesions The longer the period of observation and the greater the care given to detection of mild cases, the greater the proportion of patients who are found to develop signs of MS; however, most do so within 5 years of the original attack (Ebers, Hely et al) In fact, in many patients with clinically isolated optic neuritis, MRI has disclosed lesions of the cerebral white matter suggesting that dissemination, albeit asymptomatic, had already occurred and thereby establishing the diagnosis of MS (Jacobs et al, Ormerod et al) The Optic Neuritis Study Group has made the point, well known to neurologists, that the recurrence of optic neuritis greatly increases the chances of developing MS It is unclear whether optic neuritis that occurs alone and is not followed by other evidence of demyelinating disease is simply a restricted form of MS or a manifestation of some other disease process, such as postinfectious encephalomyelitis By far the most common pathologic basis for optic neuritis is demyelinative disease, though it is known that a vascular lesion or compression of an optic nerve by a tumor or mucocele may cause a central or cecocentral scotoma that is indistinguishable from the defect of optic neuritis Also, there may exist a special form of chronic relapsing optic neuritis that is due to an unde ned granulomatous process such as sarcoid and not to MS, as suggested by Kidd and colleagues Spinal cord lesions have developed months or years later in almost all such cases under our care Uveitis and sheathing of the retinal veins are other ophthalmic. mvc display pdf in partial view ASP.NET MVC 6 - UNA… por Walter Montes Delgado [PDF/iPad ...
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