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Eighty-six patients with monosymptomatic optic neuritis of unknown cause were followed prospectively for a median period of 12.9 years.At onset, cerebrospinal fluid(CSF)pleocytosis was present in 46 patients(53%)but oligoclonal immunoglobulin in only 40(47%)of the patients.The human leukocyte antigen(HLA)-DR2 was present in 45(52).Clinically definite multiple sclerosis(MS)was established in 33 patients.Actuarial analysis showed that the cumulative probability of developing MS within 15 years was 45%.Three risk factors were identified:low age and abnormal CSF at onset,and early recurrence of optic neuritis.Female gender,onset in the winter season,and the presence of HLA-DR2 antigen increased the risk for MS,but not significantly.Magnetic resonance imaging detected bilateral discrete white matter lesions,similar to those in MS,in 11 of 25 patients, 7 to 18 years after the isolated attack of optic neuritis.Nine were among the 13 with abnormal CSF and only 2 belonged to the group of 12 with normal CSF(p=0.01).Normal CSF at the onset of optic neuritis conferred better prognosis but did not preclude the development of MS. |
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cerebrospinal fluid
cerebrospinal fluid,abnormal
cerebrospinal fluid,oligoclonal IgG in
HLA
MRI,abnormal
multiple sclerosis
optic neuritis
optic neuritis,recurrent
pleocytosis of cerebrospinal fluid
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