BILATERAL ACUTE OPTIC NEURITIS - PROSPECTIVE CLINICAL, MRI, CSF, NEUROPHYSIOLOGICAL AND HLA FINDINGS

This paper presents the clinical picture and the results of a battery of tests performed in a prospective study of 30 patients (aged 15-53 y ears; 14 females) consecutively referred during a six-and-a-half-year period and suffering from bilateral acute optic neuritis (BAON) accord ing to clinical criteria. Both eyes were affected within a time span o f six weeks. Ten patients showed papillitis in one or both eyes. Cause s of BAON other than clinically definite multiple sclerosis (CDMS), pr esent in 12 patients, were carefully ruled out and all relevant blood tests were normal, having excluded two patients with Leber's optic neu ropathy. Tissue typing showed HLA-DR15 in 12 patients. The proportion of abnormal results at onset was 14/27=52% (cerebral MRI), 23/30=77% ( VEP), 11/27=41% (SEP), 10/24=42% (biotesiometry), 8/20=40% (CSF oligoc lonal bands), 10/26=38% (IgG-index), and 9/25=36% (CSF leukocyte count ). One year from onset, 24 patients were reexamined; another two patie nts were followed clinically and with VEP only. Abnormal results were observed by MRT in 13/21=62%, by VEP in 21/26=81%, by SEP in 6/23=26%, and by biotesiometry in 9/24=38%. Five patients had developed CDMS. T he visual acuity improved in one or both eyes in 19, remained unchange d in four, and deteriorated in three patients. The frequency of abnorm al VEP, IgG-index, and oligoclonal bands was significantly lower in id iopathic cases than in patients with CDMS. Abnormal results tended to be less frequent when symptoms occurred simultaneously (n=15), suggest ing simultaneous BAON to be more rarely a part of MS. Bilateral idiopa thic cases seemed to show abnormal CSF, MRT, and VEP findings less fre quently than unilateral cases.