• Vol. 38 No. 9, 821–826
  • 15 September 2009

Magnetic Resonance Imaging in Acute Optic Neuritis in Singapore

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ABSTRACT

Introduction: The Optic Neuritis Treatment Trial (ONTT) has established that the magnetic resonance imaging (MRI) findings at the time of presentation of optic neuritis (ON) is the strongest indicator of the development of multiple sclerosis (MS). Reports from Singapore as well as other Asian countries have indicated that these abnormalities are less frequently encountered compared to that reported by the ONTT. This paper aims to describe systematically the brain MRI as well as the optic nerve abnormalities in patients after an episode of acute optic neuritis. Materials and Methods: Patients who presented with acute optic neuritis were retrieved from our prospective optic neuritis study and their MRI scans were reviewed and graded in accordance with the standardised classification employed in the ONTT. Results: Fifteen of 24 patients had MRI brain and optic nerves performed during the acute episode. In the evaluation of brain abnormalities, 40% were classified as grade 0, 20% grade I, 20% grade II, 6.7% grade III and 13.3% grade IV. Optic nerve abnormalities were observed in 80% of cases. At study entry, 10 patients had idiopathic (monosymptomatic) ON, 3 had multiple sclerosis (MS), one each with infective and autoimmune optic neuritis, respectively. The single patient who developed MS at study completion presented with grade II brain abnormalities at the initial MRI. For those with idiopathic ON, our study revealed a higher percentage of grade 0-I brain changes as well as a lower lesion load compared to the ONTT. Lesion load and grade was also lower in anterior optic neuritis compared with retrobulbar disease. Conclusion: Our study revealed a lower percentage of grade II-IV brain MRI abnormalities as well as less lesion load in idiopathic ON compared to the ONTT. This may be related to the lower prevalence of MS in our predominantly Asian population. As diagnostic tests and understanding of neuromyelitis optica or Devic’s disease improves, we may see more patients being diagnosed with this condition, which may also explain our findings. Our data also showed that MRI grade and lesion load in cases of anterior ON was lower than for retrobulbar disease. MRI in ON has an essential role in characterising the disease, evaluating for associated brain lesions, and assessing prognosis in retrobulbar disease but may be less useful in anterior disease.


Optic neuritis (ON) is an inflammatory, demyelinating condition affecting the optic nerves. In Western populations, ON is frequently associated with multiple sclerosis (MS).1 The optic neuritis treatment trial (ONTT)2 has provided seminal data on the natural history of optic neuritis as well as the high and low risk profiles for the eventual development of MS.3 At 15-year follow-up, they reiterated their finding that brain magnetic resonance imaging (MRI) abnormalities at the time of an optic neuritis attack is a strong predictor of the 15-year risk of MS.4 For patients who had no brain MRI lesions at baseline, the risk of developing MS was 25% compared to 72% in patients with 1 or more lesions.

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