Untersuchungen des visuellen Systems zur Diagnose und Prognose neuroinflammatorischer Erkrankungen

Das visuelle System ist häufig betroffenen bei neuroinflammatorischen Erkrankungen, sowohl im Sinne einer Optikusneuritis (ON) als auch durch Läsionen entlang der Sehbahn, z.B. in der Sehstrahlung. Verschiedene Methoden können sowohl die Struktur als auch die Funktion des visuellen Systems untersuchen. In diesem Artikel werden die unterschiedlichen Diagnostikinstrumente mit Fokus auf die klinische Relevanz diskutiert.

Abstract

The visual system is frequently affected in neuroinflammatory diseases. While the typical clinical manifestation is optic neuritis (ON), lesions along the entire visual pathway are common. Several paraclinical tests can be used to quantify abnormalities of the visual pathway in neuroinflammatory disorders. Although an optic nerve affection is currently not included in the diagnostic criteria of multiple sclerosis (MS), these tests may be very sensitive to detect asymptomatic and symptomatic lesions at early diseases stages. Moreover, they can contribute to the differential diagnosis among neuroinflammatory diseases. Last, they may play a role in the prognosis of visual deficits, and even of overall disability.

In this article, we discuss three paraclinical tests: optical coherence tomography (OCT) of the retina, magnetic resonance imaging (MRI) of the optic nerve and visual evoked potentials (VEP), including their advantages and limitations, with a focus on their role in clinical practice.

OCT is a non-invasive, quick imaging technique that measures the thickness of retinal layers. It can quantify atrophy of the combined ganglion cell- and inner plexiform layer (GCIPL) and the peripapillary retinal nerve fiber layer (pRNFL) after ON. Moreover, it can show subclinical atrophy of these layers, especially in patients with MS. The pattern of atrophy in the OCT can contribute to the differential diagnosis among neuroinflammatory diseases.

MRI is an imaging method that plays a critical role in the diagnosis and monitoring of MS. It can capture both symptomatic and asymptomatic lesions along the entire visual pathway. MRI of the optic nerve needs specific sequences with fat saturation and possibly (for acute ON) gadolinium. The length and location of the optic nerve lesions may be useful in the differential diagnosis (e. g. MS versus neuromyelitis optica spectrum disorders).

VEP is an electrophysiological measure of the afferent visual pathway. In acute ON, the P100 latency of the VEP may be prolonged, or there may be a conduction block (absence of P100 wave). In the subacute and chronic phase after ON, VEP often remain asymmetric/abnormal. Thus, the VEP can be particularly useful in quantifying subclinical/prior optic nerve affection in neuroinflammatory diseases. In addition, VEP are possibly also markers of remyelination.

Schlüsselwörter

OCT - VEP - MRT - Sehnerv - Optikusneuritis - Multiple Sklerose

Keywords

OCT - VEP - MRI - optic nerve - optic neuritis - Multiple Sclerosis

Publication History

Article published online:
09 September 2024

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