Prise en charge des neuropathies optiques inflammatoires

Inflammatory optic neuritis (ON) represents a frequent clinical situation in neurology and ophthalmology. The most frequent evoked diagnosis is multiple sclerosis (MS). However, MS occurs in 50% only after 15 years of follow-up. This frequency drops out to 25% when brain MRI is normal and, on the opposite increases to 80% when at least one lesion is observed on brain MRI. It also increases in case of oligoclonal bands on CSF analysis. When MRI and CSF analysis are normal, ON is considered idiopathic with a suspected viral etiology. However, in several cases either a recurrence or a myelitis may occur. In the first case, the feature corresponds to relapsing inflammatory optic neuritis (RION) and in the second case to neuromyelitis optica (NMO). Nevertheless, predictive criteria of a recurrence or an extension of the disease to spinal cord remains unknown, except for anti-NMO IgG antibodies which are probably highly specific for a future evolution to NMO. In the present paper, we detail typical ON and prognosis at short- and long-term, then we discuss quickly differential diagnosis especially infectious ON, ON associated with systemic diseases, NMO and RION.