ОПТИЧЕСКИЙ НЕВРИТ ПРИ ДОБРОКАЧЕСТВЕННОМ ТЕЧЕНИИ РАССЕЯННОГО СКЛЕРОЗА (КЛИНИЧЕСКИЙ СЛУЧАЙ)

Oftal mokhirurgiya

М. С. Кривошеева¹  Е. Э. Иойлева¹ 

[1] МНТК «Микрохирургия глаза» им. акад. С.Н. Федорова»

关键词: optic neuritis;    benign multiple sclerosis;    optic nerve atrophy;    magnetic resonance imaging;    microperimetry;    оптический неврит;    рассеянный склероз;    доброкачественное течение;    микропериметрия;   

学科分类：眼科学

来源: M H T K Mikrokhirurgiya Glaza

【 摘 要 】

A benign course of multiple sclerosis is characterized by rare exacerbations of the disease, long-term remissions and the lack of severe disability within a few decades after the onset of symptoms. It is known that optic neuritis is the most common symptomatic manifestation of the disease where its relapses may be observed. Descriptions of clinical remission in multiple sclerosis longer than 30 years were not found in the literature. Purpose.To describe the dynamics of visual functions in a patient with a 36-year remission in case of benign multiple scler osis (BMS). Material and methods . At the S. Fyodorov Eye Microsurgery Federal State Institution (Moscow) the dynamics of visual functions in this female patient since the age from 22 years to 58 years. Following standard research methods were performed: computer perimetry using the Humphrey HFA II-750i device, optical coherence tomography (OCT) using the spectral optical coherence tomography Cirrus HD-OCT (Carl Zeiss Meditec Inc., USA), computer Microperimetry MR-1 (Nidek technologies, Vigonza, Italy), magnetic resonance imaging (MRI) of the brain and orbits (Siemens Magnetom AVANTO, 3 Tl) using the T1 and T2 FLAIR and T2 Fat Saturation programs. Results.This female patient with a clinic of multiple sclerosis nonmanifested within 36 years after the first episode of optic neuritis was examined and treated at the S. Fyodorov Eye Microsurgery Federal State Institution (Moscow, Russian Federation) the patient was with visual disabilities and the interval of benign MS course was 36 years. During this period the patient suffered optic neuritis (ON) of the right eye at the age of 22 years and ON in the contra-lateral eye aged 58 years. The diagnosis of multiple sclerosis was confirmed on the basis of sub-clinical neurological deficit (intention tremor when performing finger-nose test, increased knee reflexes, instability in Romberg), a repeated episode of optic neuritis in the fellow eye, the presence of multiple T2 lesions in a typical MS localization according the McDonald criteria. After the final confirmation of the diagnosis of MS in 58 years, the first episode of ON, which occurred 36 years ago, has been identified as a manifest disease. Diagnosis: OD – Atrophy of the optic nerve. OS – Optic neuritis. Benign Relaps-Remmiting Multiple Sclerosis (BRRMS), cerebral form, the acute stage. An early start of the disease with an isolated optic mono-symptom is typical for a benign MS course. Further research of these cases, it may be useful to optimize the management tactics all patients already diagnosed MS. Conclusion . The presented clinical case of a 36-year remission of MS is rare in the clinical practice. All patients with an episode of optic neuritis in history must be supervised by an ophthalmologist and a neur ologist.

【 授权许可】

CC BY