Storoni, M; (2012) The use of pupillometry, serology, ethnicity and imaging in the diagnosis of optic neuritis. Doctoral thesis , UCL (University College London).

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Abstract

‘Acute isolated optic neuritis' may be the first manifestation of both Multiple Sclerosis (MS) and Neuromyelitis Optica (NMO). Twenty percent of patients with MS in western Europe present with optic neuritis as their first relapse (Mcdonald & Compston, 2006). NMO has been recently found to be more common amongst the Caucasian population of northern Europe than previously believed (Asgari et al, 2011). Patients with NMO may experience a long temporal delay after acute isolated optic neuritis before another relapse occurs, which can help to confirm the diagnosis (Wingerchuk et al, 2007). In such cases an episode of optic neuritis caused by NMO may be indistinguishable from optic neuritis caused by MS. This thesis explores differences in the manifestation of optic neuritis caused by MS and that caused by NMO and evaluates four ways in which the two aetiologies may be identified from one another: pupillometry, serum glial fibrillary acidic protein analysis, ethnic background considerations and MRI findings in the context of the visual pathways. The thesis begins by assessing the potential role of pupillometry in the diagnosis of optic nerve disease; eventually investigating its potential in discriminating between MS related optic neuritis and NMO related optic neuritis. The results of the first part of the thesis indicate the usefulness of pupillometry in patients with optic neuritis who show poor recovery, when tested in a chronic setting. Three further ways of differentiating optic neuritis caused by MS and NMO in an acute setting are then pursued. First, the measurement of serum Glial Fibrillary Acidic protein (GFAP) is shown to be a useful potential indicator of the presence of NMO. Second, the ethnic background of a patient is found to correlate with the risk of NMO. Third, the Magnetic Resonance (MR) image of the visual pathway of patients with optic neuritis from the two aetiologies is found to differ with regard to the lesion extent and the lesion site. The four investigative approaches tested in this thesis (pupillometry, serology testing for GFAP, assessment of ethnic background and MR image) can be combined to offer a patient with isolated optic neuritis of unknown cause a likelihood of suffering from NMO. The latter three methods may be used to assess the risk of NMO in a patient presenting acutely with optic neuritis in the absence of any other sign of underlying disease, and may allow for the appropriate management of this condition.

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