Highlights
- •Idiopathic optic neuropathy (ON) was the most prevalent diagnosis in our population.
- •Most patients presented ON atypical for optic neuritis.
- •Some patients admitted with ON have their diagnosis redefined during follow-up.
- •Idiopathic ON was the diagnostic that changed the most during follow-up.
- •Patients with “ON atypical for optic neuritis” do not change their diagnosis so often.
Abstract
Background
Optic neuropathies (ON) have several aetiologies and sometimes the diagnosis established
ab initio is redefined after further investigations and/or new neurological events. We aim
with this study to report clinical, paraclinical findings, treatment choices and disease
course in patients admitted with a suspicion of acute or subacute optic neuropathy
and to explore the diagnosis redefinition during follow-up and evaluate possible predictive
factors that may influence that change.
Methods
We retrospectively reviewed the medical records of 156 patients with ON admitted to
the ward of our Neurology Department, between January 2004 and August 2019. Clinical,
laboratory and imaging data, as well as treatment protocols and follow-up were analysed.
Results
At the time of discharge from the ward, our cohort comprised 83 idiopathic ON (53.2%),
38 multiple sclerosis-related ON (24.4%), 23 ischemic ON (14.7%), 5 neuromyelitis
optica spectrum disorder-related ON (3.2%), 1 Chronic relapsing inflammatory optic
neuropathy (0.6%), 1 Leber hereditary optic neuropathy (0.6%), 1 vitamin B12 deficiency
ON (0.6%), 2 Behçet ON (1.3%), 1 systemic lupus erythematosus – associated ON (0.6%),
1 syphilitic ON (0.6%). During follow-up, 129 patients retained the ward's discharge
diagnosis (82.7%) while in 27 it was redefined (17.3%). The median time between admission
and change in diagnosis was 12.3 (5.4 - 42.9) months. 67.1% of valid patients manifested
atypical characteristics of optic neuritis (presence of one of the following clinical
findings: bilateral eye involvement, visual acuity ≤ 0.1 at admission, worsening or
non-substantial recovery of visual acuity during hospitalization), while only 32.9%
presented with ON typical for optic neuritis. Idiopathic ON was the “etiology” at
discharge that changed the most during follow-up both in ON typical and atypical for
optic neuritis. More than a half of the individuals with MS-RON in our study presented
visual acuity at admission ≤ 0.1. Multivariate Cox regression analysis demonstrated
that the patients with ON atypical for optic neuritis had lower risk of having the
initial diagnosis changed (HR = 0.320, 95% CI = 0.138–0.743, p = 0.008).
Conclusion
Our study illustrates that some patients admitted with ON may have their diagnosis
redefined during follow-up and it demonstrates that patients with ON atypical for
optic neuritis are those in which the diagnosis is more likely to remain during follow-up.
Furthermore, our population has clinical and paraclinical characteristics that reinforce
conclusions from previous international studies.
Keywords
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Article info
Publication history
Published online: June 24, 2020
Accepted:
June 23,
2020
Received in revised form:
June 22,
2020
Received:
April 22,
2020
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
