Infectious optic neuropathy

Approach to the patient with acute monocular visual loss

Acute visual loss in one eye is a common symptom brought to the attention of the practicing neurologist. In this circumstance, it is critical to identify whether visual loss is due to an optic neuropathy or an ocular disorder (especially retinal disease). This review addresses the elements of the history and examination that are useful in evaluating a patient with visual loss, with the goals of correctly localizing the lesion and constructing a likely differential diagnosis.

Approach to optic neuropathies: clinical update

Visual loss is a common symptom brought to the attention of the practicing neurologist. In this circumstance, the proper identification of an optic neuropathy is critical. Recognition of key clinical clues will permit the clinician to construct a likely differential diagnosis and pursue appropriate testing. This review first addresses the elements of the history and examination which are most useful in evaluating a patient with visual loss, and then briefly discusses the main entities responsible for causing unilateral and bilateral optic neuropathies.

[The optic neuropathies]

Clinical diagnosis of optic neuropathies is based on the association of visual loss, altered color vision, relative afferent pupillary defect (if the optic neuropathy is unilateral), and changes in optic nerve appearance. Clinical characteristics often allow an etiologic diagnosis. This article emphasizes the two most common causes of optic neuropathies: inflammatory optic neuritis in younger people and anterior ischemic optic neuropathy in older people.

Optic neuropathy in cancer patients. Report of a case possibly related to 5 fluorouracil toxicity and review of the literature

We report the case of a 72-year-old woman suffering from bone metastatic breast cancer and treated with continuous intravenous 5 fluorouracil (5FU) chemotherapy, who presented with a bilateral asymmetric anterior optic neuropathy (ON). A deficiency of dihydropyrimidine dehydrogenase (DPD) was documented. Patients with DPD deficiency are at increased risk for developing unusual and/or severe toxicity to 5FU. We discuss the differential diagnosis of anterior ON and we suggest that 5FU can be responsible for optic nerve toxicity in patients with DPD deficiency.