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The optic nerve sheath on MRI in acute optic neuritis

  • Diagnostic Neuroradiology
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Abstract

Optic nerve sheath dilatation or gadolinium-enhancement on magnetic resonance imaging in acute optic neuritis have been previously reported but have been thought to be rare occurrences. This study recruited 33 patients with acute unilateral optic neuritis. All had their optic nerves imaged with fat-saturated fast spin-echo (FSE) imaging, and 28 had imaging before and after triple-dose gadolinium-enhanced fat-saturated T1-weighted imaging. Follow-up imaging was performed on 20 patients (15 following gadolinium). A dilated subarachnoid space at the anterior end of the symptomatic optic nerve on FSE imaging was seen in 15/33 cases. In three of these cases, dilatation was visible on short-term follow-up. Optic nerve sheath enhancement was seen in 21/28 cases acutely: seven at the anterior end of the lesion only, five at the posterior end only and nine at both ends. Optic sheath enhancement was seen in 13 patients on follow-up. This study suggests that optic nerve sheath dilatation on FSE images and optic nerve sheath enhancement on triple-dose gadolinium-enhanced images are common findings in acute optic neuritis. Optic nerve sheath dilatation may be due to inflammation of the optic nerve, with its associated swelling, interrupting the communication between the subarachnoid space of the diseased optic nerve and the chiasmal cistern. Optic nerve sheath enhancement suggests that meningeal inflammation occurs in optic neuritis, in agreement with pathological studies of both optic neuritis and multiple sclerosis.

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Acknowledgements

S.J.H. is supported by The Wellcome Trust. The NMR Research Unit is supported by the Multiple Sclerosis Society of Great Britain and Northern Ireland.

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Authors and Affiliations

  1. NMR Research Unit, Department of Neuroinflammation, Institute of Neurology, University College London, Queen Square, London, WC1N 3BG, UK

    S. J. Hickman & D. H. Miller

  2. Department of Neuro-Ophthalmology, Moorfields Eye Hospital, City Road, London, EC1V 2PD, UK

    S. J. Hickman & G. T. Plant

  3. Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK

    K. A. Miszkiel

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  1. S. J. Hickman
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  2. K. A. Miszkiel
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  3. G. T. Plant
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  4. D. H. Miller
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Correspondence to D. H. Miller.

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Hickman, S.J., Miszkiel, K.A., Plant, G.T. et al. The optic nerve sheath on MRI in acute optic neuritis. Neuroradiology 47, 51–55 (2005). https://doi.org/10.1007/s00234-004-1308-x

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  • DOI: https://doi.org/10.1007/s00234-004-1308-x

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