Document Detail


Sarcoidosis of the anterior visual pathway: 24 new cases.
MedLine Citation:
PMID:  14504590     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To describe the clinical spectrum and a rational approach to the diagnosis of anterior visual pathway sarcoidosis. METHODS: Retrospective chart review of all patients examined in neuro-ophthalmic consultation by 1 author from 1989 to 1998 with a diagnosis of sarcoidosis. RESULTS: There were 24 patients (17 female, 7 male, mean age 40 years) with anterior visual pathway sarcoidosis, 17 (71%) of whom were not previously known to have sarcoidosis. Visual acuity ranged from 20/20 to NLP. Normal fundi were observed in 15%. Among the 85% who had fundus abnormalities, pallor was present in 55%, disc edema in 26%, periphlebitis/sheathing in 14%, and optic disc granuloma in 10%. Ten patients (42%) had uveitis, active in only 3 (13%). An elevated angiotensin-converting enzyme (ACE) was present in 16 (76%) of 21 patients tested; evidence of sarcoidosis on chest radiograph was present in 13 (72%) of 18; gallium scanning was abnormal in 13 (93%) of 14; neuroimaging abnormalities of the optic nerves, chiasm, or tract were present in 16 (70%) of 23; lymphocytic pleocytosis or elevated cerebrospinal fluid protein was identified in 14 (88%) of 16 patients, with both values elevated in 7 (44%) patients. Histologic confirmation was obtained in 13 (81%) of 16 who underwent biopsy; in the remaining patients, diagnosis was based entirely on clinical and laboratory evidence. CONCLUSIONS: Anterior visual pathway disease may be underrecognized as a presentation of sarcoidosis. Classic fundus findings of periphlebitis and optic granuloma are typically absent. An aggressive diagnostic evaluation may help establish the diagnosis early in its course.
Authors:
Larry P Frohman; Medhat Guirgis; Roger E Turbin; Leonard Bielory
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society     Volume:  23     ISSN:  1070-8022     ISO Abbreviation:  J Neuroophthalmol     Publication Date:  2003 Sep 
Date Detail:
Created Date:  2003-09-23     Completed Date:  2003-11-20     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9431308     Medline TA:  J Neuroophthalmol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  190-7     Citation Subset:  IM    
Affiliation:
Institute of Ophthalmology and Visual Sciences, UMDNJ-New Jersey Medical School, 90 Bergen Street, Newark, NJ 07103, USA. Frohman@umdnj.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Diagnostic Techniques, Ophthalmological*
Eye Diseases / diagnosis,  etiology
Female
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Optic Nerve Diseases / complications,  diagnosis*
Sarcoidosis / complications,  diagnosis*
Visual Acuity
Visual Pathways / pathology*
Comments/Corrections
Comment In:
J Neuroophthalmol. 2003 Sep;23(3):187-9   [PMID:  14504589 ]

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