Postpartum optic neuritis: Etiologic and pathophysiologic considerations

The clinical course of four patients with visual loss in the postpartum per iod due to acute optic neuritis is described. Factors that disclosed the un derlying etiology and expression of disease are discussed. The clinical rec ords of four women examined and managed for visual loss after uncomplicated pregnancies and term deliveries were reviewed. Neurodiagnostic examination , treatment modalities, and outcomes were assessed. These four women with v aried and confounding medical histories, all with optic neuropathy, eventua lly were demonstrated to harbor demyelinating disease. Although visual loss in the postpartum period evokes differential diagnostic considerations, th e authors' experience suggests that puerperal immune-mediated changes are r esponsible for activation of optic neuritis associated with relapsing multi ple sclerosis.