Resumen
La neuritis óptica (NO) es la inflamación primaria del nervio óptico asociada con frecuencia a desmielinización, y en muchos casos puede ser el primer episodio de un paciente que va a desarrollar esclerosis múltiple (EM) con el tiempo.
Es de naturaleza progresiva en pocas semanas, en su mayoría asociada a dolor retro-ocular, alteración de la sensibilidad al contraste y evidencia de defecto pupilar aferente. Casi siempre tiene buen pronóstico de recuperación.
La resonancia magnética (RM) cerebral es esencial para identificar a los pacientes en riesgo de EM y los potenciales evocados nos pueden ayudar en pacientes en que está cuestionado el diagnóstico de EM. El LCR puede mostrar anormalidades leves con presencia de bandas oligoclonales aunque no se tiene claro el valor predictivo de este hallazgo en cuanto al desarrollo de EM especialmente si la RM es anormal.
El tratamiento del evento agudo se hace con metilprednisolona IV seguido de prednisolona oral y el manejo crónico en pacientes con alto riesgo de desarrollar EM se realiza con interferones.
Finalmente, siempre es importante tener en cuenta el diagnóstico de NMO, especialmente en pacientes con NO recurrentes y RM no sugestiva de EM. En estos casos el pronóstico y tratamiento de la enfermedad varía.
Citas
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