Caracterização etiológica e clínica das neurites ópticas infecciosas

Lana-Peixoto, Marco Aurélio; Pereira, Fabiano M.; Veloso, Evaldo D.

doi:10.1590/S0004-282X1997000200012

Resumos

As neurites ópticas infecciosas (NOI) foram estudadas em relação aos aspectos etiológicos, epidemiológicos e clínicos, com o intuito de detectar características que possam diferencia-las das neurites ópticas desmielinizantes (NOD), que apresentam nítida tendência para conversão em esclerose múltipla. Entre 105 casos de NOI, 51 não apresentavam qualquer evidência de envolvimento da coróide ou retina e poderiam ser confundidos com NOD. Envolvimento bilateral foi encontrado em 23 pacientes (45,1%), sendo simultâneo em 18 (78,3%) casos. A relação entre sexos foi 2M: IF. As idades variaram ente 1 a 82 anos, com mediana de 34,8 anos. Um terço dos pacientes tinha idades até 20 anos, e em um terço dos pacientes as idades eram igual ou maior que 50 anos. Sífilis foi encontrada em 19 pacientes sendo a causa mais comum das NOI, enquanto infecções virais diversas foram responsabilizadas em 41,2%. A acuidade visual foi gravemente afetada na maioria dos casos, sendo pior que 20/200 em 57,3% dos olhos acometidos. Distúrbios da visão cromática foram encontrados em 91,8%, enquanto o exame do campo visual revelou anormalidades em 92,6% dos olhos, predominando os defeitos centrais (40,7%). O disco óptico estava anormal em 90,5% dos olhos examinados, sendo atrofia óptica o principal achado fundoscópico. O presente estudo demonstra que a maior tendência a bilateralidade e simultaneidade das NOI, sua maior prevalência no sexo masculino, na infância e em adultos após os 50 anos de idade, assim como a maior severidade do comprometimento das funções visuais diferem substancialmente das características relatadas nas NOD. O conhecimento destas diferenças pode auxiliar na diferente abordagem terapêutica e prognostica das duas distintas condições.

neurites ópticas infecciosas; neurites ópticas desmielinizantes; esclerose múltipla; características epidemiológicas e clínicas

Fifty-one patients with infectious optic neuritis (ION) with no associated choroidal or retinal involvement were studied in relation to the etiologic agents, and to the epidemiological and clinical features to look up features which could be used to distinct them from the demyelinating optic neuritis (DON) which have a well-known tendency to convert to multiple sclerosis. Bilateral involvement was found in 23 patients (45.1 %), simultaneously in 18 cases. Sex distribution was 2M:1F. The ages ranged from 1 to 82 years (median 34.8); 1/3 of the patients were younger than 20 and 1/3 were 50 years of age or older. Syphilis was found in 19 patients being the single most common etiology, whereas viral infetions were found in 41.2% of the cases. Visual acuity was severely damaged in most patients and was worse than 20/200 in 57.3% of the involved eyes. Color vision was affected in 91.8%. Visual field defects were found in 92.2%, with predominance of the central defects (40.7%). The optic disc was abnormal in 90.5% of the eyes. This study clearly demonstrates that ION and DON have distinct epidemiological and clinical features. The awareness of these differences may help clinicians to follow different paths for the correct diagnosis and appropriate treatment and prognostic orientation of their patients.

infectious optic neuritis; demyelinating optic neuritis; multiple sclerosis; epidemiological and clinical features

Caracterização etiológica e clínica das neurites ópticas infecciosas

Etiological and clinical characteristics of infectious optic neuritis

Marco Aurélio Lana-Peixoto^I; Fabiano M. Pereira^II; Evaldo D. Veloso^II

^IDepartamento de Neurologia da Faculdade de Medicina da Universidade Federal de Minas Gerais e Departamento de Neuro-Oftalmologiado Instituto Hilton Rocha, Belo Horizonte, Minas Gerais. Professor Adjunto de Neurologia

^IIDepartamento de Neurologia da Faculdade de Medicina da Universidade Federal de Minas Gerais e Departamento de Neuro-Oftalmologiado Instituto Hilton Rocha, Belo Horizonte, Minas Gerais. Acadêmico de Medicina

RESUMO

As neurites ópticas infecciosas (NOI) foram estudadas em relação aos aspectos etiológicos, epidemiológicos e clínicos, com o intuito de detectar características que possam diferencia-las das neurites ópticas desmielinizantes (NOD), que apresentam nítida tendência para conversão em esclerose múltipla. Entre 105 casos de NOI, 51 não apresentavam qualquer evidência de envolvimento da coróide ou retina e poderiam ser confundidos com NOD. Envolvimento bilateral foi encontrado em 23 pacientes (45,1%), sendo simultâneo em 18 (78,3%) casos. A relação entre sexos foi 2M: IF. As idades variaram ente 1 a 82 anos, com mediana de 34,8 anos. Um terço dos pacientes tinha idades até 20 anos, e em um terço dos pacientes as idades eram igual ou maior que 50 anos. Sífilis foi encontrada em 19 pacientes sendo a causa mais comum das NOI, enquanto infecções virais diversas foram responsabilizadas em 41,2%. A acuidade visual foi gravemente afetada na maioria dos casos, sendo pior que 20/200 em 57,3% dos olhos acometidos. Distúrbios da visão cromática foram encontrados em 91,8%, enquanto o exame do campo visual revelou anormalidades em 92,6% dos olhos, predominando os defeitos centrais (40,7%). O disco óptico estava anormal em 90,5% dos olhos examinados, sendo atrofia óptica o principal achado fundoscópico. O presente estudo demonstra que a maior tendência a bilateralidade e simultaneidade das NOI, sua maior prevalência no sexo masculino, na infância e em adultos após os 50 anos de idade, assim como a maior severidade do comprometimento das funções visuais diferem substancialmente das características relatadas nas NOD. O conhecimento destas diferenças pode auxiliar na diferente abordagem terapêutica e prognostica das duas distintas condições.

Palavras-chave: neurites ópticas infecciosas, neurites ópticas desmielinizantes, esclerose múltipla, características epidemiológicas e clínicas.

ABSTRACT

Fifty-one patients with infectious optic neuritis (ION) with no associated choroidal or retinal involvement were studied in relation to the etiologic agents, and to the epidemiological and clinical features to look up features which could be used to distinct them from the demyelinating optic neuritis (DON) which have a well-known tendency to convert to multiple sclerosis. Bilateral involvement was found in 23 patients (45.1 %), simultaneously in 18 cases. Sex distribution was 2M:1F. The ages ranged from 1 to 82 years (median 34.8); 1/3 of the patients were younger than 20 and 1/3 were 50 years of age or older. Syphilis was found in 19 patients being the single most common etiology, whereas viral infetions were found in 41.2% of the cases. Visual acuity was severely damaged in most patients and was worse than 20/200 in 57.3% of the involved eyes. Color vision was affected in 91.8%. Visual field defects were found in 92.2%, with predominance of the central defects (40.7%). The optic disc was abnormal in 90.5% of the eyes. This study clearly demonstrates that ION and DON have distinct epidemiological and clinical features. The awareness of these differences may help clinicians to follow different paths for the correct diagnosis and appropriate treatment and prognostic orientation of their patients.

Key- words: infectious optic neuritis, demyelinating optic neuritis, multiple sclerosis, epidemiological and clinical features

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Aceite: 3-fevereiro-1997.

Dr. Marco Aurélio Lana - Departamento de Neuro-Oftalmologia, Instituto Hilton Rocha - Av. Anel da Sena 1355, Mangabeiras - 30210-090 Belo Horizonte MG - Brasil.

1. Allsop JL, McLeod JG, Gye RS. Cryptococcal meningitis. Proc Australian Assoc Netirol 1970;7:71-76.
2. Arnold RW, Schriever G. Lyme amaurosis in a child. J Pediatr Ophthalmol Strabismus 1993;30:268-270.
3. Beardsley TJ, Brown SVL, Sydnor CF, Klintworth GK. Eleven cases of sarcoidosis of the optic nerve. Am .J Opthalmol 1984;97:62-77.
4. Berliner ML. Acute optic neuritis in demyelinating diseases of the nervous system. Arch Ophthalmol 1935;13:83-98.
5. Bomiat FX, Herbort CP. Herpes zoster ophthalmicus: anterior ischemic optic neuropathy and acyclovir. J Clin Neuro Ophthalmol 1992; 1237-1240.
6. Bradley WG, Whitty CM. Acute optic neuritis: its clinical features and their relation to prognosis for recovery of vision. J Neurol Neurosurg Psychiatry 1967;30:531 -538.
7. Chusid MC. Williamson S.I. Murphy J V. Ramcy LS. Neuromyelitis optica (Devic's disease) following varicella infection. .J Pediatr 1979:95:737-738.
8. DeBroff BM, Donahue SP. Bilateral optic neuropathy as the initial manifestation of systemic sarcoidosis. Am J Ophthalmol 1993;116:108-111.
9. Ebers GC. Optic neuritis and multiple sclerosis. Arch Neurol 1985;42:702-704.
10. Edgerton AE. Herpes zoster ophthalmicus: report of cases and review of the literature. Arch Ophthalmol 1945,34:40-62.
11. Foster RE, Loder CY, Meisler DM, Kosmorsky GS, Baetz-Greenwalt B. Mumps neuroretinitis in an adolescent. Am .J Ophthalmol 1990;110:91-93.
12. Gill WD. Ocular symptomatology in dengue based on an analysis of 1241 cases. Arch Ophthalmol 1928:57:628-638.
13. Günduz K, Özdemir O. Bilateral retrobulbar neuritis following unilateral herpes zoster ophthalmicus. Ophthalmologia 1994;208:61-64.
14. Halperin LS. Neuroretinitis due to seronegative syphilis associated with human immunodeficiency virus. J Clin NeuroOphthalmol 1992; 12:171 -172.
15. Halperin LS, Berger AS, Grand MG. Syphlitic disc edema and periphlebitis. Retina 1990;10:223-225.
16. Hendarto SK, Hadinegoro SR. Dengue encephalopathy. Acta Paediatr Jpn 1992;34:350-357.
17. Hiatt RL, Grizzard JT, McNeer P, Jabour JT. Ophthalmologic manifestations of subacute sclerosing panencephalitis. Trans Am Acad Ophthalmol Otolaryngol 1971,75:344-350.
18. Iraci G. Giordano R, Gerosa MA, Pardatscher K, Tamazzoli L. Tuberculoma of the anterior optic pathways: a case report. J Neurosurg 1980;52:129-133.
19. Johns DR, Tierney M, Felsenstein D. Alteration in the natural history of neurosyphilis by concurrent infection with the human immunodeficiency virus. N Engl J Med 1987;316:1569-1572.
20. Johnson BL. Wisotzkey HM. Neuroretinitis associated with herpes simplex encephalitis in an adult. Am J Ophthalmol 1977:83:481-489.
21. Lana-Peixoto MA. Multiple sclerosis and positive Lyme serology. Arq Neuropsiquiatr 1994;52:566-571.
22. Lana-Peixoto MA, Bambina E, Pittella JEH: Optic nerve tuberculoma: a case report. Arch Neurol 1980:37:186-187.
23. Lana-Peixoto MA, Lana-Peixoto MI. The risk of multiple sclerosis developing in patients with isolated idiopathic optic neuritis in Brasil. Arq Neuropsiquiatr 1991;49:377-383.
24. Lana-Peixoto MA, Reis IL. Neurite óptica cm doença de Lyme. Arq Neuropsiquiatr 1992:50(Suppl): 192.
25. Lesser RL, Kornmehl EW, Pachner AR, Kattah J, Hedges TR III, Newman NM, Ecer PA, Glassman MI. Neuro-ophthalmologic manifestations of Lyme disease. Ophthalmology 1990:97:699-706.
26. McBurney J, Rosenberg ML. Unilateral syphilitc optic perineuritis presenting as the big blind spot syndrome. J Clin NeuroOphthalmol 1987-7:167-169.
27. McLeish WM, Pulido JS. Holland S, Culbertson WW, Winward K. The ocular manifestations of syphilis in the human immunodefciency virus type 1-infected host. Ophthalmology 1990,97:196-203.
28. Meadows SP. Retrobulbar and optic neuritis in childhood and adolescence. Trans Ophthalmol Soc UK 1969;89:63-638.
29. Miller BW, Frcnkel M. Report of a case with tuberculous retrobulbar neuritis and osteomyelitis. Am J Ophthalmol 1971 ;71:751 -756.
30. Miller DH, Kay R, Schon F, McDonald WI, Haas LF, Hughes RAC. Optic neuritis following chickenpox in adults. J Neurol 1986;233:182-184.
31. Miller NR. Viruses and viral diseases. In Miller NR. Walsh and Hoyt's clinical neuro-ophthalmology. Baltimore: Williams & Wilkins. 1995:3795-4266.
32. Okun F, Buller WT. Ophthalmologic complications of cryptococcal meningitis. Arch Ophthalmol 1964:7:52-57.
33. Optic Neuritis Study Group. The clinical profile of the optic neuritis: experience of the neuritis treatment trial. Arch Ophthalmol 1991:109:1673-1678.
34. Perkin GD, Rose FC. Optic neuritis and its differential diagnosis. Oxford: Oxford Univ Press, 1979.
35. Radda TM, Gnad HD, Ulrich W. Okklusive Arteriitis bei Herpes zoster ophthalmicus. Klin Monastbl Augenheilkd l983;183:387-388.
36. Rex JH, Larsen RA, Dismukes WE, Cloud GA, Bennett JE. Catastrophic visual loss due to Crylococcus neoformans meningtis. Medicine 1993:72:207-224.
37. Scharf Y, Kraus E, Zonis S. Optic neuropathy and central retinal artery occlusion in a case of herpes zoster ophthalmicus. Ann Opthalmol 1987;19:77-78
38. Strong LE, Henderson JW, Gingitano JL. Bilateral retrobulbar neuritis secondary to mumps. Am J Ophthalmol 1974; 1978:331 -332.
39. Takahashi T, Isayama Y. Chiasmal meningitis. NeuroOphthalmol 1980; 1:19-31.
40. Tomsak RL, Lyslad LD, Katirji MB, Brassel TC. Rapid response of syphilitic optic neuritis to posterior sub-Tenon steroid injection. .J Clin NeuroOphthaimol 1992; 12:6-7.
41. Tyler HR. Neurological complications of rubeola (measles). Medicine 1957;36:147-167.
42. Wu G, Lincoff H, Ellsworth RM. Haik. BG. Optic disc edema and Lyme disease. Ann Ophthalmol 1986: 18:252-255.
43. Zambrano W, Perez GM, Smith JL. Neurosyphilis and retrobulbar neuritis in a patient with AIDS. J Clin NeuroOphthalmol 1986;18:260-261.

Datas de Publicação

Publicação nesta coleção
10 Nov 2010
Data do Fascículo
Jun 1997

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Allsop JL, McLeod JG, Gye RS. Cryptococcal meningitis. Proc Australian Assoc Netirol 1970;7:71-76.

[2] 2. Arnold RW, Schriever G. Lyme amaurosis in a child. J Pediatr Ophthalmol Strabismus 1993;30:268-270.

[3] 3. Beardsley TJ, Brown SVL, Sydnor CF, Klintworth GK. Eleven cases of sarcoidosis of the optic nerve. Am .J Opthalmol 1984;97:62-77.

[4] 4. Berliner ML. Acute optic neuritis in demyelinating diseases of the nervous system. Arch Ophthalmol 1935;13:83-98.

[5] 5. Bomiat FX, Herbort CP. Herpes zoster ophthalmicus: anterior ischemic optic neuropathy and acyclovir. J Clin Neuro Ophthalmol 1992; 1237-1240.

[6] 6. Bradley WG, Whitty CM. Acute optic neuritis: its clinical features and their relation to prognosis for recovery of vision. J Neurol Neurosurg Psychiatry 1967;30:531 -538.

[7] 7. Chusid MC. Williamson S.I. Murphy J V. Ramcy LS. Neuromyelitis optica (Devic's disease) following varicella infection. .J Pediatr 1979:95:737-738.

[8] 8. DeBroff BM, Donahue SP. Bilateral optic neuropathy as the initial manifestation of systemic sarcoidosis. Am J Ophthalmol 1993;116:108-111.

[9] 9. Ebers GC. Optic neuritis and multiple sclerosis. Arch Neurol 1985;42:702-704.

[10] 10. Edgerton AE. Herpes zoster ophthalmicus: report of cases and review of the literature. Arch Ophthalmol 1945,34:40-62.

[11] 11. Foster RE, Loder CY, Meisler DM, Kosmorsky GS, Baetz-Greenwalt B. Mumps neuroretinitis in an adolescent. Am .J Ophthalmol 1990;110:91-93.

[12] 12. Gill WD. Ocular symptomatology in dengue based on an analysis of 1241 cases. Arch Ophthalmol 1928:57:628-638.

[13] 13. Günduz K, Özdemir O. Bilateral retrobulbar neuritis following unilateral herpes zoster ophthalmicus. Ophthalmologia 1994;208:61-64.

[14] 14. Halperin LS. Neuroretinitis due to seronegative syphilis associated with human immunodeficiency virus. J Clin NeuroOphthalmol 1992; 12:171 -172.

[15] 15. Halperin LS, Berger AS, Grand MG. Syphlitic disc edema and periphlebitis. Retina 1990;10:223-225.

[16] 16. Hendarto SK, Hadinegoro SR. Dengue encephalopathy. Acta Paediatr Jpn 1992;34:350-357.

[17] 17. Hiatt RL, Grizzard JT, McNeer P, Jabour JT. Ophthalmologic manifestations of subacute sclerosing panencephalitis. Trans Am Acad Ophthalmol Otolaryngol 1971,75:344-350.

[18] 18. Iraci G. Giordano R, Gerosa MA, Pardatscher K, Tamazzoli L. Tuberculoma of the anterior optic pathways: a case report. J Neurosurg 1980;52:129-133.

[19] 19. Johns DR, Tierney M, Felsenstein D. Alteration in the natural history of neurosyphilis by concurrent infection with the human immunodeficiency virus. N Engl J Med 1987;316:1569-1572.

[20] 20. Johnson BL. Wisotzkey HM. Neuroretinitis associated with herpes simplex encephalitis in an adult. Am J Ophthalmol 1977:83:481-489.

[21] 21. Lana-Peixoto MA. Multiple sclerosis and positive Lyme serology. Arq Neuropsiquiatr 1994;52:566-571.

[22] 22. Lana-Peixoto MA, Bambina E, Pittella JEH: Optic nerve tuberculoma: a case report. Arch Neurol 1980:37:186-187.

[23] 23. Lana-Peixoto MA, Lana-Peixoto MI. The risk of multiple sclerosis developing in patients with isolated idiopathic optic neuritis in Brasil. Arq Neuropsiquiatr 1991;49:377-383.

[24] 24. Lana-Peixoto MA, Reis IL. Neurite óptica cm doença de Lyme. Arq Neuropsiquiatr 1992:50(Suppl): 192.

[25] 25. Lesser RL, Kornmehl EW, Pachner AR, Kattah J, Hedges TR III, Newman NM, Ecer PA, Glassman MI. Neuro-ophthalmologic manifestations of Lyme disease. Ophthalmology 1990:97:699-706.

[26] 26. McBurney J, Rosenberg ML. Unilateral syphilitc optic perineuritis presenting as the big blind spot syndrome. J Clin NeuroOphthalmol 1987-7:167-169.

[27] 27. McLeish WM, Pulido JS. Holland S, Culbertson WW, Winward K. The ocular manifestations of syphilis in the human immunodefciency virus type 1-infected host. Ophthalmology 1990,97:196-203.

[28] 28. Meadows SP. Retrobulbar and optic neuritis in childhood and adolescence. Trans Ophthalmol Soc UK 1969;89:63-638.

[29] 29. Miller BW, Frcnkel M. Report of a case with tuberculous retrobulbar neuritis and osteomyelitis. Am J Ophthalmol 1971 ;71:751 -756.

[30] 30. Miller DH, Kay R, Schon F, McDonald WI, Haas LF, Hughes RAC. Optic neuritis following chickenpox in adults. J Neurol 1986;233:182-184.

[31] 31. Miller NR. Viruses and viral diseases. In Miller NR. Walsh and Hoyt's clinical neuro-ophthalmology. Baltimore: Williams & Wilkins. 1995:3795-4266.

[32] 32. Okun F, Buller WT. Ophthalmologic complications of cryptococcal meningitis. Arch Ophthalmol 1964:7:52-57.

[33] 33. Optic Neuritis Study Group. The clinical profile of the optic neuritis: experience of the neuritis treatment trial. Arch Ophthalmol 1991:109:1673-1678.

[34] 34. Perkin GD, Rose FC. Optic neuritis and its differential diagnosis. Oxford: Oxford Univ Press, 1979.

[35] 35. Radda TM, Gnad HD, Ulrich W. Okklusive Arteriitis bei Herpes zoster ophthalmicus. Klin Monastbl Augenheilkd l983;183:387-388.

[36] 36. Rex JH, Larsen RA, Dismukes WE, Cloud GA, Bennett JE. Catastrophic visual loss due to Crylococcus neoformans meningtis. Medicine 1993:72:207-224.

[37] 37. Scharf Y, Kraus E, Zonis S. Optic neuropathy and central retinal artery occlusion in a case of herpes zoster ophthalmicus. Ann Opthalmol 1987;19:77-78

[38] 38. Strong LE, Henderson JW, Gingitano JL. Bilateral retrobulbar neuritis secondary to mumps. Am J Ophthalmol 1974; 1978:331 -332.

[39] 39. Takahashi T, Isayama Y. Chiasmal meningitis. NeuroOphthalmol 1980; 1:19-31.

[40] 40. Tomsak RL, Lyslad LD, Katirji MB, Brassel TC. Rapid response of syphilitic optic neuritis to posterior sub-Tenon steroid injection. .J Clin NeuroOphthaimol 1992; 12:6-7.

[41] 41. Tyler HR. Neurological complications of rubeola (measles). Medicine 1957;36:147-167.

[42] 42. Wu G, Lincoff H, Ellsworth RM. Haik. BG. Optic disc edema and Lyme disease. Ann Ophthalmol 1986: 18:252-255.

[43] 43. Zambrano W, Perez GM, Smith JL. Neurosyphilis and retrobulbar neuritis in a patient with AIDS. J Clin NeuroOphthalmol 1986;18:260-261.