| Identifier |
Optic_Perineuritis |
| Title |
Optic Perineuritis |
| Creator |
Andrew G. Lee, MD; Amelia Khoei |
| Affiliation |
(AGL) Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, Texas; Professor of Ophthalmology, Weill Cornell Medicine, New York City, New York; (AK) Class of 2022, Baylor College of Medicine, Houston, Texas |
| Subject |
Optic Perineuritis; Diagnosis; Granulomatous |
| Description |
Dr. Lee lectures medical students on optic perineuitis. |
| Transcript |
All right, today we're going to be talking about optic perineuritis, and optic perineuritis means that it's around the optic nerve. So if this is the optic nerve, so its "peri" (like perimeter) is the sheath. So it's perineuritis when it involves the optic nerve sheath. So, in axial on the MRI scan we get this tram-tracking sign because the sheath is enhancing. And on the coronal on the MRI we get like a target or the enhancement is in the sheath. So clinically what this looks like is it's any age patient, although they're often younger. They have acute onset of loss of vision in the affected eye. It can be unilateral or bilateral. And often the pain is out of proportion to the findings. It's not like demyelinating optic neuritis where they have pain with eye movement. It's normally pain with eye movement with severe pain. And so, any age, acute onset, unilateral, or bilateral optic neuropathy with a RAPD if it's bilateral. And often the optic disc is swollen, but it can be normal. So when we have disc edema, acute onset, pain, imaging studies showing peri-neuritis rather than parenchymal enhancement - that's when you should really be thinking about optic perineuritis. And we see optic perineuritis that some conditions like to involve the parenchyma like demyelinatic optic neuritis. And some like to be in the sheath. So the things that like to be in the sheath are granulomatous disease (especially sarcoidosis), but any kind of granuloma can go into the sheath like this. And IgG4. Any kind of orbital inflammatory pseudotumor can involve the sheath and look radiographically and clinically like optic perineuritis. And MOG. So MOG is the new kid on the block in terms of enhancement of the sheath. Often it's like shaggy enhancement going out into the fat, and they have disc edema and severe pain, but no demyelinating white matter lesions on the MRI. If you do the whole work up and it's negative, we normally just treat with steroids empirically. And if we don't find anything, we're going to call it idiopathic optic perineuritis. But you should work it up for the usual suspects: syphilis, sarcoid, tuberculosis, it could always be a lymphoma. And so if it doesn't get better with steroids or recurs during the taper we might still have to do a diagnostic biopsy. But most of the time we just treat empirically and test for the labs for sarcoidosis. We're going to do a chest x-ray and an AC, but sometimes CT of the chest is necessary. So in summary, optic perineuritis looks different than optic neuritis. It usually is young people but it can be any age. It presents with an acute, unilateral optic neuropathy. The pain is usually disproportionately greater than the demyelinating optic neuritis which just produeces pain without movement. It can be unilateral or bilateral. Theyre going to have an RAPD, and they might have optic disc edema. You should be thinking about sarcoid, IgG4, MOG. If the work up is negative, treat with steroids. And if nothing comes up and it doesn't recur, it's idiopathic. If it recurs or persists, you might have to biopsy it because other infiltrative things including infiltrative neoplasm like lymphoma can go right into the sheath. |
| Date |
2020-05-27 |
| Language |
eng |
| Format |
video/mp4 |
| Type |
Image/MovingImage |
| Collection |
Neuro-Ophthalmology Virtual Education Library: Andrew G. Lee Collection: https://novel.utah.edu/Lee/ |
| Publisher |
North American Neuro-Ophthalmology Society |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Rights Management |
Copyright 2019. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6x69206 |
| Setname |
ehsl_novel_lee |
| ID |
1561516 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6x69206 |
