Optic neuropathy in imaging | Radiología (English Edition)

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Sobral Viñas, E. Santos Armentia, N. Silva Priegue, S. del Campo Estepar, R. Alemán Millares, A. Pérez Fernández" "autores" => array:6 [ 0 => array:4 [ "nombre" => "P." "apellidos" => "Sobral Viñas" "email" => array:1 [ 0 => "paula.sobral.vinas@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Santos Armentia" ] 2 => array:2 [ "nombre" => "N." "apellidos" => "Silva Priegue" ] 3 => array:2 [ "nombre" => "S." "apellidos" => "del Campo Estepar" ] 4 => array:2 [ "nombre" => "R." "apellidos" => "Alemán Millares" ] 5 => array:2 [ "nombre" => "A." "apellidos" => "Pérez Fernández" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Radiodiagnóstico, Hospital Povisa, Vigo, Pontevedra, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Neuropatía óptica en imagen" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0060" "etiqueta" => "Figure 12" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr12.jpeg" "Alto" => 1777 "Ancho" => 1667 "Tamanyo" => 221394 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0060" "detalle" => "Figure 1" "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "39-year-old woman who attended accident and emergency due to sudden left hemiparesis, headache and fever, complaining of mouth sores and painful genitalia for at least three years. MRI of the brain was performed. A) Hyperintense signal in both optic nerves (arrows) on coronal FLAIR-SPIR sequence. B) Axial FLAIR sequence with signal alteration at right thalamus (circle). C) Axial T1-weighted image with IV contrast shows right thalamus hypointense and not enhanced (circle). The patient was finally diagnosed with neuro-Behçet’s disease after ruling out infectious aetiology, also compatible with clinical presentation." ] ] ] "textoCompleto" => "<elsevierMultimedia ident="tb0001"></elsevierMultimedia>IntroductionThe optic pathway is composed of different neural structures involved in the processing of visual information, including the visual cortex, the optic radiations, the lateral geniculate body, the optic tracts, the optic chiasm and finally the optic nerve.<a class="elsevierStyleCrossRef" href="#bib0005">1</a>The optic nerve has four segments: intraocular (from the retina to the sclera), intraorbital (from the back of the eyeball to the optic canal), intracanalicular (inside the optic canal) and intracranial (from the exit of the bony canal to the chiasm). It is composed of retinal ganglion cell axons that converge at the optic disc and are enveloped by a myelin sheath (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<a class="elsevierStyleCrossRef" href="#bib0010">2</a><elsevierMultimedia ident="fig0005"></elsevierMultimedia>Optic neuropathy consists of damage to the optic nerve that can cause a wide range of clinical manifestations depending on the triggering aetiology,<a class="elsevierStyleCrossRef" href="#bib0015">3</a> such as amaurosis, afferent pupillary defect, central scotoma, dyschromatopsia or papillitis.<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0030">–In the acute phase, inflammation of the optic nerve occurs, which can be identified as signal hyperintensity on magnetic resonance imaging (MRI).</li><li class="elsevierStyleListItem" id="lsti0035">–In chronic phases, optic nerve atrophy may develop.</li></ul>An accurate clinical history is fundamental in the differential diagnosis of the diseases that cause optic neuropathy. It should always take into account the age of presentation, an examination of the fundus, optical coherence tomography (OCT) and MRI, since, as will be explained throughout the sections of this paper, treatment varies considerably in the different aetiologies of optic neuropathy.The aim of this paper is to develop a diagnostic approach to the possible causes of optic nerve disease. It focuses on the different imaging findings of diseases that include optic neuropathy as the main manifestation (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>MRI findingsAlthough there is no standardised protocol for the specific assessment of optic neuropathy with MRI, axial and coronal T1-weighted sequences without fat suppression, axial and coronal T2-weighted sequences with fat suppression (STIR) and axial and coronal T1-weighted sequences post-contrast with fat suppression are recommended. Slice thickness should be less than 3 mm. The orbit and cavernous sinus should be included in both the axial and coronal sequences.<a class="elsevierStyleCrossRef" href="#bib0020">4</a>Typically, findings are most easily identified in the retrobulbar intraorbital segment of the optic nerve, which appears enlarged, with hyperintensity in T2. Enhancement of the nerve following contrast administration is best identified in coronal T1-weighted images with fat suppression, and is observed in more than 90% of patients if the MRI is performed within 20 days following loss of vision<a class="elsevierStyleCrossRef" href="#bib0025">5</a> (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). However, it should be noted that enhancement can disappear following the administration of corticosteroids. For this reason, if an accurate diagnosis is desired, the MRI should be performed before starting treatment.<elsevierMultimedia ident="fig0010"></elsevierMultimedia>AetiologyIschaemic optic neuropathyIschaemic optic neuropathy is the most frequent cause of optic neuropathy, and is generally found in patients over 50 years old. It can be anterior (if it affects the optic disc) or posterior (retrobulbar) and non-arteritic or arteritic (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).<elsevierMultimedia ident="fig0015"></elsevierMultimedia>Non-arteriticNon-arteritic ischaemic anterior optic neuropathy (NA-AION) is the most common cause of ischaemic optic neuropathy. The clinical picture consists of sudden, non-painful loss of vision or blurred vision. It is associated with cardiovascular risk factors which are targeted for treatment: hypertension, diabetes mellitus, hypercholesterolaemia, smoking, sleep apnoea, coronary heart disease, anaemia, etc. (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). In MRI it is very difficult to identify a signal alteration or enhancement of the optic nerve.<a class="elsevierStyleCrossRef" href="#bib0030">6</a> There is no effective treatment for this pathology, which casts a shadow over the prognosis. Recurrence in the same eye is rare. The cumulative risk of vision loss on the contralateral side is 14.7% over the next 5 years.<a class="elsevierStyleCrossRef" href="#bib0035">7</a><elsevierMultimedia ident="fig0020"></elsevierMultimedia>ArteriticGenerally occurs in patients over 70 years old and, frequently, is secondary to giant cell arteritis/temporal arteritis. Clinical presentation varies, including temple pain, pain on chewing, paraesthesia and unilateral headaches, asthenia and fever, with laboratory abnormalities consisting of elevated acute phase reactants (APR). Binocular/Bilateral involvement occurs in a third of cases, normally from day one.<a class="elsevierStyleCrossRef" href="#bib0040">8</a> Treatment consists of corticosteroid therapy, which should be started as soon as possible<a class="elsevierStyleCrossRef" href="#bib0045">9</a> (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>).<elsevierMultimedia ident="fig0025"></elsevierMultimedia>DemyelinatingOligodendrocytes are the glial cells responsible for forming the myelin sheath that covers the axons of the optic nerve.In demyelinating diseases, the myelin sheath is damaged by autoimmune responses, causing inflammation and damage to the optic nerve (<a class="elsevierStyleCrossRef" href="#fig0030">Fig. 6</a>).<elsevierMultimedia ident="fig0030"></elsevierMultimedia>Multiple sclerosisThe main cause of optic neuropathy of demyelinating aetiology is multiple sclerosis. Multiple sclerosis is a progressive autoimmune disease, characterised by the appearance of demyelinating plaques predominantly on white matter. Optic neuritis is the first manifestation in 20–30% of patients and up to 50% will develop it at some point during the course of the disease. The disease predominates in young women.<a class="elsevierStyleCrossRef" href="#bib0050">10</a>There are various therapeutic options, including systemic corticosteroids, interferon-beta, glatiramer acetate, or monoclonal antibodies (natalizumab, etc.).<a class="elsevierStyleCrossRef" href="#bib0055">11</a>Diagnosis requires an adequate medical history, together with additional tests such as MRI of the brain and spine, fundus/OCT examination and lumbar puncture (detection of oligoclonal bands). MRI of the brain plays a fundamental role, as lesions on the optic nerve are predominantly longitudinally short and generally unilateral<a class="elsevierStyleCrossRef" href="#bib0060">12</a> (<a class="elsevierStyleCrossRef" href="#fig0035">Fig. 7</a>).<elsevierMultimedia ident="fig0035"></elsevierMultimedia>Neuromyelitis optica spectrum disorderNeuromyelitis optica spectrum disorder is an autoimmune disease secondary to anti-aquaporin-4 (anti-AQP4) autoantibodies (present on the surface of astrocytes), that predominantly affects the optic pathway and the spinal cord, corresponding to immune-mediated astrocytopathy. It is nine times more frequent in women than men and typically affects patients between 30–40 years of age (later than in multiple sclerosis).<a class="elsevierStyleCrossRef" href="#bib0065">13</a>Diagnosis requires an adequate medical history, together with additional tests such as MRI of the brain and spinal cord, fundus examination, OCT and blood tests (to test for anti-AQP-4 autoantibodies, results of which are not always positive).<a class="elsevierStyleCrossRef" href="#bib0070">14</a> There are a number of therapeutic options depending on the severity of the condition: corticosteroids, immunosuppressants, plasmapheresis, etc.Optic nerve involvement predominantly comes in the form of bilateral retrobulbar optic neuritis (involvement that predominates in the most posterior segment of the optic nerve and the chiasma)<a class="elsevierStyleCrossRef" href="#bib0020">4</a> (<a class="elsevierStyleCrossRef" href="#fig0040">Fig. 8</a>).<elsevierMultimedia ident="fig0040"></elsevierMultimedia>Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD)MOGAD is a rare disorder, predominantly presenting with bilateral optic neuritis.It is predominantly seen in childhood and in the fourth decade of life. It may be monophasic or follow a recurrent or relapsing course. Up to almost half of patients have a previous history of infection or vaccination.<a class="elsevierStyleCrossRef" href="#bib0020">4</a>To diagnose this disease, an anti-MOG test (IgG-MOG) test must be performed. These may be present in a wide range of diseases giving false positives, particularly at low levels. Depending on the seriousness of the symptoms, treatment options include corticosteroid therapy, immunosuppressants and plasmapheresis.<a class="elsevierStyleCrossRef" href="#bib0020">4</a>In this disorder, optic nerve involvement predominantly consists of bilateral optic neuritis, with longitudinally extensive lesions and is associated with papillitis (<a class="elsevierStyleCrossRef" href="#fig0045">Fig. 9</a>), with ill-defined parenchymal lesions in the white matter, that mimic those seen in acute disseminated encephalomyelitis (ADEM), where the deep grey matter may also be implicated with uni- or bilateral lesions to the thalamus. After contrast administration, enhancement is ill-defined.<a class="elsevierStyleCrossRefs" href="#bib0080">15,16</a><elsevierMultimedia ident="fig0045"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#fig0050">Fig. 10</a> provides a summary of the different patterns of optic nerve involvement in the demyelinating diseases.<elsevierMultimedia ident="fig0050"></elsevierMultimedia>InflammatorySarcoidosisSarcoidosis is an autoimmune granulomatous disease, which predominantly affects the lungs and the lymph nodes. It affects patients between 20 and 50 years of age, predominantly women.Additional tests include radiography and chest CT, biopsy and, should neurosarcoidosis be suspected, brain MRI (<a class="elsevierStyleCrossRef" href="#fig0055">Fig. 11</a>). Elevated levels of angiotensin-converting enzyme (ACE) are present in the cerebrospinal fluid. Systemic corticosteroids play a fundamental role in treatment.<a class="elsevierStyleCrossRef" href="#bib0090">17</a><elsevierMultimedia ident="fig0055"></elsevierMultimedia>Optic neuropathy occurs in up to 5% of patients with sarcoidosis. Involvement varies, including: papilloedema, atrophy, papillitis, retrobulbar neuritis or optic nerve infiltration.<a class="elsevierStyleCrossRef" href="#bib0090">17</a>Besides optic neuritis, the disease can involve other cranial nerves (often causing facial paralysis), parenchymal lesions (that may manifest as low T2-weighted signal due to their high cellularity) or leptomeningeal enhancement; thickening of the pituitary stalk resulting in endocrine abnormalities (diabetes insipidus, SIADH, hyperprolactinemia, etc.) or hydrocephalus.<a class="elsevierStyleCrossRefs" href="#bib0095">18,19</a>Neuro-Behçet’s diseaseBehçet’s disease is an autoimmune disorder characterised by mouth and genital sores, that can present with optic neuritis among other manifestations. It predominates in young people between 20 and 40 years of age, and neuro-Behçet’s disease develops in approximately 5–15% of patients.<a class="elsevierStyleCrossRef" href="#bib0105">20</a>The diagnostic process requires an adequate medical history, a positive pathergy test and lab analytics (elevated PCR, leucocytosis, etc.).Therapy consists fundamentally of anti-inflammatories and immunosuppressants, azathioprine, methotrexate, ciclosporin or anti-TNF for the eye disease.<a class="elsevierStyleCrossRef" href="#bib0110">21</a>Eye involvement most frequently manifests as uveitis, and where optical neuritis develops it tends to be bilateral<a class="elsevierStyleCrossRef" href="#bib0115">22</a> (<a class="elsevierStyleCrossRef" href="#fig0060">Fig. 12</a>).<elsevierMultimedia ident="fig0060"></elsevierMultimedia>CRION (chronic relapsing inflammatory optic neuropathy)An autoimmune optic neuropathy without systemic disease, characterised by a rapid response to corticosteroid treatment with the reappearance of symptoms when this treatment is suspended. It predominates in women, who present with sharp pain upon eye movement, followed by subacute vision loss. Treatment consists of immunosuppressant therapy (corticosteroids, azathioprine, etc.).<a class="elsevierStyleCrossRef" href="#bib0120">23</a>Diagnosis is by exclusion, with brain MRI being useful to identify signs of optic neuropathy, which most frequently affects the intraorbital segment of the optic nerve (<a class="elsevierStyleCrossRef" href="#fig0065">Fig. 13</a>).<elsevierMultimedia ident="fig0065"></elsevierMultimedia>LupusA complex autoimmune disease characterised by the involvement of multiple organs with a wide range of clinical manifestations. In Spain, prevalence is estimated at 9 in every 10,000 inhabitants.<a class="elsevierStyleCrossRef" href="#bib0125">24</a>Lupus tends to manifest together with clinical and analytic data relating to the inflammatory aspects of the disease. Diagnosis involves an investigation into a series of clinical criteria that, together with an antinuclear antibody test, imaging tests (chest radiography, echocardiogram, etc.) and biopsy, present a challenge to the physician responsible for the patient.<a class="elsevierStyleCrossRef" href="#bib0130">25</a>Depending on the clinical manifestations, therapeutic options include non-steroidal anti-inflammatory drugs, corticosteroids, anti-malarial drugs, immunosuppressants and biopharmaceuticals.Optic neuropathy affects 1% of patients, and can manifest as acute retrobulbar optic neuritis, papillitis, ischaemic neuropathy or progressive loss of visual acuity (<a class="elsevierStyleCrossRef" href="#fig0070">Fig. 14</a>).<a class="elsevierStyleCrossRef" href="#bib0135">26</a><elsevierMultimedia ident="fig0070"></elsevierMultimedia>Other aetiologiesOther disorders may accompany optic neuropathy. These are less frequent than those mentioned above, and include glaucoma, compressive optic neuropathy (as can be seen in aneurysms, with orbital pseudotumours or in idiopathic intracranial hypertension) and in neoplasia (optic glioma, meningioma, metastasis or lymphoma) and secondary to radiotherapy treatment.<a class="elsevierStyleCrossRef" href="#bib0140">27</a>Optic neuropathy secondary to radiation presents clinically as acute, painless, irreversible loss of vision in patients treated with brain or orbital radiotherapy. The vast majority of patients who develop this complication display symptoms prior to three years post-treatment, with an incidence peak at one year,<a class="elsevierStyleCrossRef" href="#bib0140">27</a> and require additional tests such as campimetry and MRI (<a class="elsevierStyleCrossRef" href="#fig0075">Fig. 15</a>).<elsevierMultimedia ident="fig0075"></elsevierMultimedia>Regarding imaging findings, the optic nerve becomes inflamed, with enhancement following administration of intravenous contrast and altered signal in the initial phases, with atrophy in the later stages. Treatment is not clearly established if aetiology is unknown: hyperbaric oxygen, corticosteroids, anticoagulants, anti-VEGF drugs, etc.<a class="elsevierStyleCrossRef" href="#bib0145">28</a>ConclusionsMRI findings are fundamental to the differential diagnosis of the different diseases that present with optic neuropathy as the main clinical manifestation, helping to localise and characterise various types of diseases, whether they are specific to the optic pathway or involve various levels of the central nervous system, increasing diagnostic accuracy.Author contributions<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0040">1Research coordinators: PSV, ESA, NSP, SdCE, RAM and APF.</li><li class="elsevierStyleListItem" id="lsti0045">2Development of study concept: PSV, ESA, NSP, SdCE, RAM and APF.</li><li class="elsevierStyleListItem" id="lsti0050">3Study design: PSV, ESA, NSP, SdCE, RAM and APF.</li><li class="elsevierStyleListItem" id="lsti0055">4Data collection: N/A.</li><li class="elsevierStyleListItem" id="lsti0060">5Data analysis and interpretation: N/A.</li><li class="elsevierStyleListItem" id="lsti0065">6Statistical analysis: N/A.</li><li class="elsevierStyleListItem" id="lsti0070">7Literature search: PSV, ESA, NSP, SdCE, RAM and APF.</li><li class="elsevierStyleListItem" id="lsti0075">8Writing of article: PSV and ESA.</li><li class="elsevierStyleListItem" id="lsti0080">9Critical review of the manuscript with intellectually relevant contributions: PSV, ESA, NSP, SdCE, RAM and APF.</li><li class="elsevierStyleListItem" id="lsti0085">10Approval of the final version: PSV, ESA, NSP, SdCE, RAM and APF.</li></ul>Conflicts of interestThe authors declare that they have no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres2274125" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1895264" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2274126" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1895265" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0010" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0015" "titulo" => "MRI findings" ] 6 => array:3 [ "identificador" => "sec0020" "titulo" => "Aetiology" "secciones" => array:6 [ 0 => array:3 [ "identificador" => "sec0025" "titulo" => "Ischaemic optic neuropathy" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Non-arteritic" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Arteritic" ] ] ] 1 => array:3 [ "identificador" => "sec0040" "titulo" => "Demyelinating" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0045" "titulo" => "Multiple sclerosis" ] 1 => array:2 [ "identificador" => "sec0050" "titulo" => "Neuromyelitis optica spectrum disorder" ] 2 => array:2 [ "identificador" => "sec0055" "titulo" => "Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD)" ] ] ] 2 => array:3 [ "identificador" => "sec0060" "titulo" => "Inflammatory" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0065" "titulo" => "Sarcoidosis" ] 1 => array:2 [ "identificador" => "sec0070" "titulo" => "Neuro-Behçet’s disease" ] ] ] 3 => array:2 [ "identificador" => "sec0075" "titulo" => "CRION (chronic relapsing inflammatory optic neuropathy)" ] 4 => array:2 [ "identificador" => "sec0080" "titulo" => "Lupus" ] 5 => array:2 [ "identificador" => "sec0085" "titulo" => "Other aetiologies" ] ] ] 7 => array:2 [ "identificador" => "sec0090" "titulo" => "Conclusions" ] 8 => array:2 [ "identificador" => "sec0095" "titulo" => "Author contributions" ] 9 => array:2 [ "identificador" => "sec0100" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-04-12" "fechaAceptado" => "2023-06-07" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1895264" "palabras" => array:5 [ 0 => "Optic neuropathy" 1 => "Optic nerve" 2 => "Magnetic resonance" 3 => "Ischemic" 4 => "Demyelinating" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1895265" "palabras" => array:5 [ 0 => "Neuropatía óptica" 1 => "Nervio óptico" 2 => "Resonancia magnética" 3 => "Isquémica" 4 => "Desmielinizante" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "The aim of this work is to provide a diagnostic approach to the potential causes of optic neuropathy, focusing on the radiological findings associated with this pathology. Various etiologies have been identified, including inflammatory and demyelinating optic neuritis, developmental and hereditary diseases, neurodegenerative disorders, infectious conditions, post-traumatic causes, ischemic optic neuropathy (with anterior ischemic optic neuropathy being the most common form), and neoplastic etiologies. Optical coherence tomography and magnetic resonance imaging play a fundamental role in the diagnosis of optic neuropathy, allowing to distinguish patterns of optic nerve involvement. These studies are essential to locate and characterize the different pathologies, increasing the precision of the diagnosis in diseases presenting optic neuropathy as the main symptom. In conclusion, the findings obtained from magnetic resonance imaging are essential in the differential diagnosis of optic nerve diseases, aiding in the localization and characterization of various pathologies affecting either the optic pathway alone or multiple levels of the central nervous system and thereby increasing diagnostic accuracy." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "Este trabajo tiene como objetivo realizar una aproximación diagnóstica de las posibles causas de neuropatía óptica, enfocándose en los hallazgos radiológicos de dicha entidad. Se han identificado diferentes etiologías, como neuritis ópticas inflamatorias y desmielinizantes, enfermedades del desarrollo y hereditarias, neurodegenerativas, infecciosas, postraumáticas, isquémicas y tumorales. La tomografía de coherencia óptica y la resonancia magnética desempeñan un papel crucial en el diagnóstico, permitiendo distinguir los patrones de afectación y orientar el diagnóstico diferencial. Estos estudios son fundamentales para localizar y caracterizar las diferentes patologías, aumentando la precisión del diagnóstico en enfermedades que presentan neuropatía óptica como síntoma principal. En conclusión, los hallazgos obtenidos mediante resonancia magnética son esenciales en el diagnóstico diferencial de las posibles causas de neuropatía óptica, ayudando en la localización y caracterización de diversas patologías que afectan tanto a la vía óptica como a múltiples niveles del sistema nervioso central, mejorando así la precisión diagnóstica." ] ] "multimedia" => array:17 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2098 "Ancho" => 2514 "Tamanyo" => 353550 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Anatomy of the optic pathway." ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2333 "Ancho" => 2764 "Tamanyo" => 437678 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "45-year-old woman with clinical presentation indicative of acute bilateral optic neuritis. A and B) FLAIR sequences with fat suppression (A) axial (B) coronal: signal hyperintensity and increased thickness of optic nerves (arrows). C and D) T1 sequences with fat suppression and IV contrast (C) axial and (D) coronal: enhancement of optic nerves (arrows) and blurring of the adjacent fat. After the imaging tests and analysing the cerebrospinal fluid, the patient was diagnosed with a neuromyelitis optica spectrum disorder." ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 2764 "Ancho" => 2931 "Tamanyo" => 654643 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Types of optic neuropathy of ischaemic aetiology." ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 3063 "Ancho" => 2931 "Tamanyo" => 596842 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "75-year-old man with diabetes and hypertension, smoker, who presented with symptoms that suggest left optic neuritis. In the MRI, altered signal in relation to the left optic nerve is observed, with bilateral carotid atheroma, findings that correspond to a non-arteritic anterior ischaemic optic neuropathy (NA-AION). FLAIR sequences in the axial (from above) and coronal (from below) planes are shown, where the circle and arrow indicate the hyperintense signal relating to the left optic nerve in comparison with the opposite side. The atheroma plaques in the carotid arteries are visible in the ultrasound images (arrows)." ] ] 4 => array:8 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 2875 "Ancho" => 2931 "Tamanyo" => 553376 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "70-year-old woman with left unilateral pain. Three days later she presented with loss of visual acuity in the left eye. In the MRI, signal alteration to the petrous segment of the left intracranial ICA, with wall enhancement in the black blood sequence, corresponding to an arteritic anterior ischaemic optic neuropathy (A-AION), giant cell arteritis. A) In the axial T2-weighted sequence, the circle marks the petrous segment of the carotid artery. B) Axial T1-weighted sequence with intravenous contrast and fat suppression, where the arrow indicates the petrous segment of the carotid artery. C) Coronal T1-weighted sequence with IV contrast, where the arrow indicates the petrous segment of the carotid artery. D) Volumetric reconstruction where the arrows indicate the carotid artery, the calibre of which presents as smaller than the carotid artery on the other side." ] ] 5 => array:8 [ "identificador" => "fig0030" "etiqueta" => "Figure 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 1069 "Ancho" => 1667 "Tamanyo" => 108916 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Diagram describing the myelin covering of the optic nerve, formed by oligodendrocytes." ] ] 6 => array:8 [ "identificador" => "fig0035" "etiqueta" => "Figure 7" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr7.jpeg" "Alto" => 1444 "Ancho" => 1667 "Tamanyo" => 204941 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0035" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Examples of optic neuritis secondary to multiple sclerosis in an MRI of the brain. A and B) 30-year-old woman with loss of visual acuity in left eye. A: Axial FLAIR sequence with signal alteration at left optic nerve (arrow). B: Coronal FLAIR sequence with signal alteration at left optic nerve (arrow). C and D) 28-year-old woman who attended the clinic for amaurosis with onset two days prior. C: Axial FLAIR sequence with signal alteration at left optic nerve (arrow). D: left optic nerve enhancement (arrow) in coronal T1-weighted sequence with IV contrast." ] ] 7 => array:8 [ "identificador" => "fig0040" "etiqueta" => "Figure 8" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr8.jpeg" "Alto" => 1611 "Ancho" => 1667 "Tamanyo" => 221101 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0040" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "47-year-old woman with neuromyelitis optica spectrum disorder. The brain MRI shows: A) Signal alteration relating to both optic nerves (arrows) with chiasm involvement in a coronal FLAIR sequence. B) Signal alteration relating to both optic nerves (arrows) with chiasm involvement in axial FLAIR sequence. C) Hyperintense spinal cord lesion at C2 level (arrow) in proton-density weighted sequence (sagittal section). D) Hyperintense spinal cord lesion at C2 level (arrow) in T2-weighted sequence (sagittal section)." ] ] 8 => array:8 [ "identificador" => "fig0045" "etiqueta" => "Figure 9" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr9.jpeg" "Alto" => 1382 "Ancho" => 1667 "Tamanyo" => 207513 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0045" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "24-year-old patient with clinical presentation indicative of bilateral optic neuritis due to MOG antibody disease. Brain MRI shows: (A) bilateral enhancement of the nerve and optic nerve sheath (arrows) on the axial T1 with IV contrast; (B) bilateral enhancement of the nerve and optic nerve sheath (arrows) on the coronal T1 with IV contrast; (C) signal alteration of both optic nerves (arrows), compatible with bilateral optic neuritis on axial FLAIR sequence; and (D) signal alteration of both optic nerves (arrows) compatible with bilateral optic neuritis on coronal FLAIR sequence." ] ] 9 => array:8 [ "identificador" => "fig0050" "etiqueta" => "Figure 10" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr10.jpeg" "Alto" => 1180 "Ancho" => 1550 "Tamanyo" => 183682 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0050" "detalle" => "Figure 1" "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Summary of optic nerve involvement patterns in neuritis of demyelinating aetiology. Axial FLAIR sequences are shown (multiple sclerosis and optic neuromyelitis) and axial T1 with IV contrast (anti-MOG antibody)." ] ] 10 => array:8 [ "identificador" => "fig0055" "etiqueta" => "Figure 11" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr11.jpeg" "Alto" => 1069 "Ancho" => 1667 "Tamanyo" => 142307 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0055" "detalle" => "Figure 1" "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "48-year-old woman with clinical presentation indicative of retrobulbar optic neuritis at one week. The MRI shows: (A) enhancement of the left optic nerve in the T1-weighted image with IV contrast (axial section); (B) enhancement of the left optic nerve (arrow) in the T1-weighted image with IV contrast (coronal section); (C) signal alteration of both optic nerves (arrows), compatible with bilateral optic neuritis on axial FLAIR sequence; and (D) signal alteration of both optic nerves (arrows) compatible with bilateral optic neuritis on coronal FLAIR sequence. Oligoclonal bands, anti-MOG antibodies and anti-AQ4 were all negative. Angiotensin-converting enzyme (ACE) in the blood was 135 (normal range 18–55). The gallium SPECT scan revealed bilateral hilar adenopathies, and finally neurosarcoidosis was diagnosed." ] ] 11 => array:8 [ "identificador" => "fig0060" "etiqueta" => "Figure 12" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr12.jpeg" "Alto" => 1777 "Ancho" => 1667 "Tamanyo" => 221394 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0060" "detalle" => "Figure 1" "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "39-year-old woman who attended accident and emergency due to sudden left hemiparesis, headache and fever, complaining of mouth sores and painful genitalia for at least three years. MRI of the brain was performed. A) Hyperintense signal in both optic nerves (arrows) on coronal FLAIR-SPIR sequence. B) Axial FLAIR sequence with signal alteration at right thalamus (circle). C) Axial T1-weighted image with IV contrast shows right thalamus hypointense and not enhanced (circle). The patient was finally diagnosed with neuro-Behçet’s disease after ruling out infectious aetiology, also compatible with clinical presentation." ] ] 12 => array:8 [ "identificador" => "fig0065" "etiqueta" => "Figure 13" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr13.jpeg" "Alto" => 1313 "Ancho" => 1667 "Tamanyo" => 216168 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0065" "detalle" => "Figure 1" "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "29-year-old man with recurring episodes of vision loss and retroocular pain, who was submitted to an MRI of the brain. A) Axial T2-GRE with thin slices where signal alteration at the optic chiasm is observed (circle). B) Coronal FLAIR-SPIR sequence with signal alteration at both optic nerves (arrows). C) Axial FLAIR sequence where atrophy of the optic nerves is observed (arrows). D) Hyperintense signal at right optic nerve on coronal FLAIR-SPIR sequence. The patient tested negative for anti-NMO antibodies and, after ruling out other aetiologies, including Leber’s optic neuropathy, and in light of the rapid clinical improvement seen with corticosteroid treatment with worsening symptoms on withdrawal, the patient was finally diagnosed with CRION." ] ] 13 => array:8 [ "identificador" => "fig0070" "etiqueta" => "Figure 14" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr14.jpeg" "Alto" => 1813 "Ancho" => 1667 "Tamanyo" => 233170 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0070" "detalle" => "Figure 1" "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "40-year-old patient with neurolupus diagnosis who presented with: A) altered signal in the basal ganglia-thalamus region (circle) in the FLAIR sequence; B) that shows no enhancements on the T1 with IV contrast; and C) with hyperintensity of the signal in the left optic nerve (circle) compatible with optic neuritis in the axial FLAIR sequence." ] ] 14 => array:8 [ "identificador" => "fig0075" "etiqueta" => "Figure 15" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr15.jpeg" "Alto" => 1598 "Ancho" => 1550 "Tamanyo" => 278486 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0075" "detalle" => "Figure 1" "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "64-year-old patient who experienced changes to their visual field 15 months after receiving radiotherapy. A) Altered signal and enhancement of optic chiasm (arrow) following IV contrast in sagittal FLAIR sequence. B) Altered signal and enhancement of both optic nerves (arrows) in axial T1 post-contrast. C) Altered signal of optic chiasm (arrow) in coronal FLAIR sequence. Finally, the patient was diagnosed with optic neuropathy secondary to radiotherapy considering the patient history and having ruled out other possible aetiologies." ] ] 15 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0080" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ischaemic optic neuropathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ArteriticNon-arteritic \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Inflammatory/demyelinating optic neuritis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Multiple sclerosisNeuromyelitis optica spectrum disorderMOG antibody disease \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Infections \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NeuroretinitisMeningitisSyphilis/Lyme’s disease \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Genetics \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Leber’s hereditary optic neuropathy \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Neoplasms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Optic nerve gliomaMeningiomaMetastasisLymphoma \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Compressive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AneurysmOrbital pseudotumourIdiopathic intracranial hypertension \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Toxic-metabolic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Trauma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3692934.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Summary table of the different aetiologies that can cause optic neuropathy." ] ] 16 => array:5 [ "identificador" => "tb0001" "tipo" => "MULTIMEDIATEXTO" "mostrarFloat" => false "mostrarDisplay" => true "texto" => array:1 [ "textoCompleto" => "Key points<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">–Optic neuropathy can be caused by multiple diseases and cause a wide range of clinical manifestations.</li><li class="elsevierStyleListItem" id="lsti0010">–MRI is the imaging technique of choice when assessing both the optic pathway and other central nervous system structures.</li><li class="elsevierStyleListItem" id="lsti0015">–Optic nerve disease is most easily identified in the retrobulbar intraorbital segment of the optic nerve.</li><li class="elsevierStyleListItem" id="lsti0020">–In the acute phase, optic neuropathy on imaging can manifest as a swelling of the nerve with a high-intensity signal on T2-weighted images and post-contrast enhancement.</li><li class="elsevierStyleListItem" id="lsti0025">–Studies of optic neuropathy require a detailed medical history, including patient demographics. 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Radiology through images

Optic neuropathy in imaging

Neuropatía óptica en imagen

P. Sobral Viñas

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paula.sobral.vinas@gmail.com

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, E. Santos Armentia, N. Silva Priegue, S. del Campo Estepar, R. Alemán Millares, A. Pérez Fernández

Servicio de Radiodiagnóstico, Hospital Povisa, Vigo, Pontevedra, Spain

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    "cabecera" => "<span class="elsevierStyleTextfn">Radiology through images</span>"
    "titulo" => "Optic neuropathy in imaging"
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        "autoresLista" => "P&#46; Sobral Vi&#241;as, E&#46; Santos Armentia, N&#46; Silva Priegue, S&#46; del Campo Estepar, R&#46; Alem&#225;n Millares, A&#46; P&#233;rez Fern&#225;ndez"
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">39-year-old woman who attended accident and emergency due to sudden left hemiparesis&#44; headache and fever&#44; complaining of mouth sores and painful genitalia for at least three years&#46; MRI of the brain was performed&#46; A&#41; Hyperintense signal in both optic nerves &#40;arrows&#41; on coronal FLAIR-SPIR sequence&#46; B&#41; Axial FLAIR sequence with signal alteration at right thalamus &#40;circle&#41;&#46; C&#41; Axial T1-weighted image with IV contrast shows right thalamus hypointense and not enhanced &#40;circle&#41;&#46; The patient was finally diagnosed with neuro-Beh&#231;et&#8217;s disease after ruling out infectious aetiology&#44; also compatible with clinical presentation&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0291" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="tb0001"></elsevierMultimedia></p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Introduction</span><p id="par0035" class="elsevierStylePara elsevierViewall">The optic pathway is composed of different neural structures involved in the processing of visual information&#44; including the visual cortex&#44; the optic radiations&#44; the lateral geniculate body&#44; the optic tracts&#44; the optic chiasm and finally the optic nerve&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The optic nerve has four segments&#58; intraocular &#40;from the retina to the sclera&#41;&#44; intraorbital &#40;from the back of the eyeball to the optic canal&#41;&#44; intracanalicular &#40;inside the optic canal&#41; and intracranial &#40;from the exit of the bony canal to the chiasm&#41;&#46; It is composed of retinal ganglion cell axons that converge at the optic disc and are enveloped by a myelin sheath &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Optic neuropathy consists of damage to the optic nerve that can cause a wide range of clinical manifestations depending on the triggering aetiology&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> such as amaurosis&#44; afferent pupillary defect&#44; central scotoma&#44; dyschromatopsia or papillitis&#46;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8211;</span><p id="par0050" class="elsevierStylePara elsevierViewall">In the acute phase&#44; inflammation of the optic nerve occurs&#44; which can be identified as signal hyperintensity on magnetic resonance imaging &#40;MRI&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">&#8211;</span><p id="par0055" class="elsevierStylePara elsevierViewall">In chronic phases&#44; optic nerve atrophy may develop&#46;</p></li></ul></p><p id="par0060" class="elsevierStylePara elsevierViewall">An accurate clinical history is fundamental in the differential diagnosis of the diseases that cause optic neuropathy&#46; It should always take into account the age of presentation&#44; an examination of the fundus&#44; optical coherence tomography &#40;OCT&#41; and MRI&#44; since&#44; as will be explained throughout the sections of this paper&#44; treatment varies considerably in the different aetiologies of optic neuropathy&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The aim of this paper is to develop a diagnostic approach to the possible causes of optic nerve disease&#46; It focuses on the different imaging findings of diseases that include optic neuropathy as the main manifestation &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">MRI findings</span><p id="par0070" class="elsevierStylePara elsevierViewall">Although there is no standardised protocol for the specific assessment of optic neuropathy with MRI&#44; axial and coronal T1-weighted sequences without fat suppression&#44; axial and coronal T2-weighted sequences with fat suppression &#40;STIR&#41; and axial and coronal T1-weighted sequences post-contrast with fat suppression are recommended&#46; Slice thickness should be less than 3&#8201;mm&#46; The orbit and cavernous sinus should be included in both the axial and coronal sequences&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Typically&#44; findings are most easily identified in the retrobulbar intraorbital segment of the optic nerve&#44; which appears enlarged&#44; with hyperintensity in T2&#46; Enhancement of the nerve following contrast administration is best identified in coronal T1-weighted images with fat suppression&#44; and is observed in more than 90&#37; of patients if the MRI is performed within 20 days following loss of vision<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; However&#44; it should be noted that enhancement can disappear following the administration of corticosteroids&#46; For this reason&#44; if an accurate diagnosis is desired&#44; the MRI should be performed before starting treatment&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Aetiology</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Ischaemic optic neuropathy</span><p id="par0080" class="elsevierStylePara elsevierViewall">Ischaemic optic neuropathy is the most frequent cause of optic neuropathy&#44; and is generally found in patients over 50 years old&#46; It can be anterior &#40;if it affects the optic disc&#41; or posterior &#40;retrobulbar&#41; and non-arteritic or arteritic &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Non-arteritic</span><p id="par0085" class="elsevierStylePara elsevierViewall">Non-arteritic ischaemic anterior optic neuropathy &#40;NA-AION&#41; is the most common cause of ischaemic optic neuropathy&#46; The clinical picture consists of sudden&#44; non-painful loss of vision or blurred vision&#46; It is associated with cardiovascular risk factors which are targeted for treatment&#58; hypertension&#44; diabetes mellitus&#44; hypercholesterolaemia&#44; smoking&#44; sleep apnoea&#44; coronary heart disease&#44; anaemia&#44; etc&#46; &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; In MRI it is very difficult to identify a signal alteration or enhancement of the optic nerve&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> There is no effective treatment for this pathology&#44; which casts a shadow over the prognosis&#46; Recurrence in the same eye is rare&#46; The cumulative risk of vision loss on the contralateral side is 14&#46;7&#37; over the next 5 years&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Arteritic</span><p id="par0090" class="elsevierStylePara elsevierViewall">Generally occurs in patients over 70 years old and&#44; frequently&#44; is secondary to giant cell arteritis&#47;temporal arteritis&#46; Clinical presentation varies&#44; including temple pain&#44; pain on chewing&#44; paraesthesia and unilateral headaches&#44; asthenia and fever&#44; with laboratory abnormalities consisting of elevated acute phase reactants &#40;APR&#41;&#46; Binocular&#47;Bilateral involvement occurs in a third of cases&#44; normally from day one&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Treatment consists of corticosteroid therapy&#44; which should be started as soon as possible<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Demyelinating</span><p id="par0095" class="elsevierStylePara elsevierViewall">Oligodendrocytes are the glial cells responsible for forming the myelin sheath that covers the axons of the optic nerve&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">In demyelinating diseases&#44; the myelin sheath is damaged by autoimmune responses&#44; causing inflammation and damage to the optic nerve &#40;<a class="elsevierStyleCrossRef" href="#fig0030">Fig&#46; 6</a>&#41;&#46;</p><elsevierMultimedia ident="fig0030"></elsevierMultimedia><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Multiple sclerosis</span><p id="par0105" class="elsevierStylePara elsevierViewall">The main cause of optic neuropathy of demyelinating aetiology is multiple sclerosis&#46; Multiple sclerosis is a progressive autoimmune disease&#44; characterised by the appearance of demyelinating plaques predominantly on white matter&#46; Optic neuritis is the first manifestation in 20&#8211;30&#37; of patients and up to 50&#37; will develop it at some point during the course of the disease&#46; The disease predominates in young women&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">There are various therapeutic options&#44; including systemic corticosteroids&#44; interferon-beta&#44; glatiramer acetate&#44; or monoclonal antibodies &#40;natalizumab&#44; etc&#46;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Diagnosis requires an adequate medical history&#44; together with additional tests such as MRI of the brain and spine&#44; fundus&#47;OCT examination and lumbar puncture &#40;detection of oligoclonal bands&#41;&#46; MRI of the brain plays a fundamental role&#44; as lesions on the optic nerve are predominantly longitudinally short and generally unilateral<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0035">Fig&#46; 7</a>&#41;&#46;</p><elsevierMultimedia ident="fig0035"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Neuromyelitis optica spectrum disorder</span><p id="par0120" class="elsevierStylePara elsevierViewall">Neuromyelitis optica spectrum disorder is an autoimmune disease secondary to anti-aquaporin-4 &#40;anti-AQP4&#41; autoantibodies &#40;present on the surface of astrocytes&#41;&#44; that predominantly affects the optic pathway and the spinal cord&#44; corresponding to immune-mediated astrocytopathy&#46; It is nine times more frequent in women than men and typically affects patients between 30&#8211;40 years of age &#40;later than in multiple sclerosis&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Diagnosis requires an adequate medical history&#44; together with additional tests such as MRI of the brain and spinal cord&#44; fundus examination&#44; OCT and blood tests &#40;to test for anti-AQP-4 autoantibodies&#44; results of which are not always positive&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> There are a number of therapeutic options depending on the severity of the condition&#58; corticosteroids&#44; immunosuppressants&#44; plasmapheresis&#44; etc&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Optic nerve involvement predominantly comes in the form of bilateral retrobulbar optic neuritis &#40;involvement that predominates in the most posterior segment of the optic nerve and the chiasma&#41;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0040">Fig&#46; 8</a>&#41;&#46;</p><elsevierMultimedia ident="fig0040"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Myelin oligodendrocyte glycoprotein antibody-associated disease &#40;MOGAD&#41;</span><p id="par0135" class="elsevierStylePara elsevierViewall">MOGAD is a rare disorder&#44; predominantly presenting with bilateral optic neuritis&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">It is predominantly seen in childhood and in the fourth decade of life&#46; It may be monophasic or follow a recurrent or relapsing course&#46; Up to almost half of patients have a previous history of infection or vaccination&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">To diagnose this disease&#44; an anti-MOG test &#40;IgG-MOG&#41; test must be performed&#46; These may be present in a wide range of diseases giving false positives&#44; particularly at low levels&#46; Depending on the seriousness of the symptoms&#44; treatment options include corticosteroid therapy&#44; immunosuppressants and plasmapheresis&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">In this disorder&#44; optic nerve involvement predominantly consists of bilateral optic neuritis&#44; with longitudinally extensive lesions and is associated with papillitis &#40;<a class="elsevierStyleCrossRef" href="#fig0045">Fig&#46; 9</a>&#41;&#44; with ill-defined parenchymal lesions in the white matter&#44; that mimic those seen in acute disseminated encephalomyelitis &#40;ADEM&#41;&#44; where the deep grey matter may also be implicated with uni- or bilateral lesions to the thalamus&#46; After contrast administration&#44; enhancement is ill-defined&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">15&#44;16</span></a></p><elsevierMultimedia ident="fig0045"></elsevierMultimedia><p id="par0155" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0050">Fig&#46; 10</a> provides a summary of the different patterns of optic nerve involvement in the demyelinating diseases&#46;</p><elsevierMultimedia ident="fig0050"></elsevierMultimedia></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Inflammatory</span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Sarcoidosis</span><p id="par0160" class="elsevierStylePara elsevierViewall">Sarcoidosis is an autoimmune granulomatous disease&#44; which predominantly affects the lungs and the lymph nodes&#46; It affects patients between 20 and 50 years of age&#44; predominantly women&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Additional tests include radiography and chest CT&#44; biopsy and&#44; should neurosarcoidosis be suspected&#44; brain MRI &#40;<a class="elsevierStyleCrossRef" href="#fig0055">Fig&#46; 11</a>&#41;&#46; Elevated levels of angiotensin-converting enzyme &#40;ACE&#41; are present in the cerebrospinal fluid&#46; Systemic corticosteroids play a fundamental role in treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">17</span></a></p><elsevierMultimedia ident="fig0055"></elsevierMultimedia><p id="par0170" class="elsevierStylePara elsevierViewall">Optic neuropathy occurs in up to 5&#37; of patients with sarcoidosis&#46; Involvement varies&#44; including&#58; papilloedema&#44; atrophy&#44; papillitis&#44; retrobulbar neuritis or optic nerve infiltration&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">17</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">Besides optic neuritis&#44; the disease can involve other cranial nerves &#40;often causing facial paralysis&#41;&#44; parenchymal lesions &#40;that may manifest as low T2-weighted signal due to their high cellularity&#41; or leptomeningeal enhancement&#59; thickening of the pituitary stalk resulting in endocrine abnormalities &#40;diabetes insipidus&#44; SIADH&#44; hyperprolactinemia&#44; etc&#46;&#41; or hydrocephalus&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">18&#44;19</span></a></p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Neuro-Beh&#231;et&#8217;s disease</span><p id="par0180" class="elsevierStylePara elsevierViewall">Beh&#231;et&#8217;s disease is an autoimmune disorder characterised by mouth and genital sores&#44; that can present with optic neuritis among other manifestations&#46; It predominates in young people between 20 and 40 years of age&#44; and neuro-Beh&#231;et&#8217;s disease develops in approximately 5&#8211;15&#37; of patients&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">20</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">The diagnostic process requires an adequate medical history&#44; a positive pathergy test and lab analytics &#40;elevated PCR&#44; leucocytosis&#44; etc&#46;&#41;&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Therapy consists fundamentally of anti-inflammatories and immunosuppressants&#44; azathioprine&#44; methotrexate&#44; ciclosporin or anti-TNF for the eye disease&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">21</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">Eye involvement most frequently manifests as uveitis&#44; and where optical neuritis develops it tends to be bilateral<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">22</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0060">Fig&#46; 12</a>&#41;&#46;</p><elsevierMultimedia ident="fig0060"></elsevierMultimedia></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">CRION &#40;chronic relapsing inflammatory optic neuropathy&#41;</span><p id="par0200" class="elsevierStylePara elsevierViewall">An autoimmune optic neuropathy without systemic disease&#44; characterised by a rapid response to corticosteroid treatment with the reappearance of symptoms when this treatment is suspended&#46; It predominates in women&#44; who present with sharp pain upon eye movement&#44; followed by subacute vision loss&#46; Treatment consists of immunosuppressant therapy &#40;corticosteroids&#44; azathioprine&#44; etc&#46;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">23</span></a></p><p id="par0205" class="elsevierStylePara elsevierViewall">Diagnosis is by exclusion&#44; with brain MRI being useful to identify signs of optic neuropathy&#44; which most frequently affects the intraorbital segment of the optic nerve &#40;<a class="elsevierStyleCrossRef" href="#fig0065">Fig&#46; 13</a>&#41;&#46;</p><elsevierMultimedia ident="fig0065"></elsevierMultimedia></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Lupus</span><p id="par0210" class="elsevierStylePara elsevierViewall">A complex autoimmune disease characterised by the involvement of multiple organs with a wide range of clinical manifestations&#46; In Spain&#44; prevalence is estimated at 9 in every 10&#44;000 inhabitants&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">24</span></a></p><p id="par0215" class="elsevierStylePara elsevierViewall">Lupus tends to manifest together with clinical and analytic data relating to the inflammatory aspects of the disease&#46; Diagnosis involves an investigation into a series of clinical criteria that&#44; together with an antinuclear antibody test&#44; imaging tests &#40;chest radiography&#44; echocardiogram&#44; etc&#46;&#41; and biopsy&#44; present a challenge to the physician responsible for the patient&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">25</span></a></p><p id="par0220" class="elsevierStylePara elsevierViewall">Depending on the clinical manifestations&#44; therapeutic options include non-steroidal anti-inflammatory drugs&#44; corticosteroids&#44; anti-malarial drugs&#44; immunosuppressants and biopharmaceuticals&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Optic neuropathy affects 1&#37; of patients&#44; and can manifest as acute retrobulbar optic neuritis&#44; papillitis&#44; ischaemic neuropathy or progressive loss of visual acuity &#40;<a class="elsevierStyleCrossRef" href="#fig0070">Fig&#46; 14</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">26</span></a></p><elsevierMultimedia ident="fig0070"></elsevierMultimedia></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Other aetiologies</span><p id="par0230" class="elsevierStylePara elsevierViewall">Other disorders may accompany optic neuropathy&#46; These are less frequent than those mentioned above&#44; and include glaucoma&#44; compressive optic neuropathy &#40;as can be seen in aneurysms&#44; with orbital pseudotumours or in idiopathic intracranial hypertension&#41; and in neoplasia &#40;optic glioma&#44; meningioma&#44; metastasis or lymphoma&#41; and secondary to radiotherapy treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">27</span></a></p><p id="par0235" class="elsevierStylePara elsevierViewall">Optic neuropathy secondary to radiation presents clinically as acute&#44; painless&#44; irreversible loss of vision in patients treated with brain or orbital radiotherapy&#46; The vast majority of patients who develop this complication display symptoms prior to three years post-treatment&#44; with an incidence peak at one year&#44;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">27</span></a> and require additional tests such as campimetry and MRI &#40;<a class="elsevierStyleCrossRef" href="#fig0075">Fig&#46; 15</a>&#41;&#46;</p><elsevierMultimedia ident="fig0075"></elsevierMultimedia><p id="par0240" class="elsevierStylePara elsevierViewall">Regarding imaging findings&#44; the optic nerve becomes inflamed&#44; with enhancement following administration of intravenous contrast and altered signal in the initial phases&#44; with atrophy in the later stages&#46; Treatment is not clearly established if aetiology is unknown&#58; hyperbaric oxygen&#44; corticosteroids&#44; anticoagulants&#44; anti-VEGF drugs&#44; etc&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">28</span></a></p></span></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusions</span><p id="par0245" class="elsevierStylePara elsevierViewall">MRI findings are fundamental to the differential diagnosis of the different diseases that present with optic neuropathy as the main clinical manifestation&#44; helping to localise and characterise various types of diseases&#44; whether they are specific to the optic pathway or involve various levels of the central nervous system&#44; increasing diagnostic accuracy&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Author contributions</span><p id="par0250" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">1</span><p id="par0255" class="elsevierStylePara elsevierViewall">Research coordinators&#58; PSV&#44; ESA&#44; NSP&#44; SdCE&#44; RAM and APF&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">2</span><p id="par0260" class="elsevierStylePara elsevierViewall">Development of study concept&#58; PSV&#44; ESA&#44; NSP&#44; SdCE&#44; RAM and APF&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">3</span><p id="par0265" class="elsevierStylePara elsevierViewall">Study design&#58; PSV&#44; ESA&#44; NSP&#44; SdCE&#44; RAM and APF&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">4</span><p id="par0270" class="elsevierStylePara elsevierViewall">Data collection&#58; N&#47;A&#46;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">5</span><p id="par0275" class="elsevierStylePara elsevierViewall">Data analysis and interpretation&#58; N&#47;A&#46;</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">6</span><p id="par0280" class="elsevierStylePara elsevierViewall">Statistical analysis&#58; N&#47;A&#46;</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">7</span><p id="par0285" class="elsevierStylePara elsevierViewall">Literature search&#58; PSV&#44; ESA&#44; NSP&#44; SdCE&#44; RAM and APF&#46;</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">8</span><p id="par0290" class="elsevierStylePara elsevierViewall">Writing of article&#58; PSV and ESA&#46;</p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">9</span><p id="par0295" class="elsevierStylePara elsevierViewall">Critical review of the manuscript with intellectually relevant contributions&#58; PSV&#44; ESA&#44; NSP&#44; SdCE&#44; RAM and APF&#46;</p></li><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">10</span><p id="par0300" class="elsevierStylePara elsevierViewall">Approval of the final version&#58; PSV&#44; ESA&#44; NSP&#44; SdCE&#44; RAM and APF&#46;</p></li></ul></p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicts of interest</span><p id="par0305" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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          "identificador" => "xres2274125"
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          "titulo" => "Introduction"
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          "identificador" => "sec0015"
          "titulo" => "MRI findings"
        ]
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          "identificador" => "sec0020"
          "titulo" => "Aetiology"
          "secciones" => array:6 [
            0 => array:3 [
              "identificador" => "sec0025"
              "titulo" => "Ischaemic optic neuropathy"
              "secciones" => array:2 [
                0 => array:2 [
                  "identificador" => "sec0030"
                  "titulo" => "Non-arteritic"
                ]
                1 => array:2 [
                  "identificador" => "sec0035"
                  "titulo" => "Arteritic"
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "sec0040"
              "titulo" => "Demyelinating"
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                0 => array:2 [
                  "identificador" => "sec0045"
                  "titulo" => "Multiple sclerosis"
                ]
                1 => array:2 [
                  "identificador" => "sec0050"
                  "titulo" => "Neuromyelitis optica spectrum disorder"
                ]
                2 => array:2 [
                  "identificador" => "sec0055"
                  "titulo" => "Myelin oligodendrocyte glycoprotein antibody-associated disease &#40;MOGAD&#41;"
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "sec0060"
              "titulo" => "Inflammatory"
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                0 => array:2 [
                  "identificador" => "sec0065"
                  "titulo" => "Sarcoidosis"
                ]
                1 => array:2 [
                  "identificador" => "sec0070"
                  "titulo" => "Neuro-Beh&#231;et&#8217;s disease"
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              ]
            ]
            3 => array:2 [
              "identificador" => "sec0075"
              "titulo" => "CRION &#40;chronic relapsing inflammatory optic neuropathy&#41;"
            ]
            4 => array:2 [
              "identificador" => "sec0080"
              "titulo" => "Lupus"
            ]
            5 => array:2 [
              "identificador" => "sec0085"
              "titulo" => "Other aetiologies"
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          "identificador" => "sec0090"
          "titulo" => "Conclusions"
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          "titulo" => "Author contributions"
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          "titulo" => "Conflicts of interest"
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          "titulo" => "References"
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    "fechaRecibido" => "2023-04-12"
    "fechaAceptado" => "2023-06-07"
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            0 => "Optic neuropathy"
            1 => "Optic nerve"
            2 => "Magnetic resonance"
            3 => "Ischemic"
            4 => "Demyelinating"
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      ]
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          "palabras" => array:5 [
            0 => "Neuropat&#237;a &#243;ptica"
            1 => "Nervio &#243;ptico"
            2 => "Resonancia magn&#233;tica"
            3 => "Isqu&#233;mica"
            4 => "Desmielinizante"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">The aim of this work is to provide a diagnostic approach to the potential causes of optic neuropathy&#44; focusing on the radiological findings associated with this pathology&#46; Various etiologies have been identified&#44; including inflammatory and demyelinating optic neuritis&#44; developmental and hereditary diseases&#44; neurodegenerative disorders&#44; infectious conditions&#44; post-traumatic causes&#44; ischemic optic neuropathy &#40;with anterior ischemic optic neuropathy being the most common form&#41;&#44; and neoplastic etiologies&#46; Optical coherence tomography and magnetic resonance imaging play a fundamental role in the diagnosis of optic neuropathy&#44; allowing to distinguish patterns of optic nerve involvement&#46; These studies are essential to locate and characterize the different pathologies&#44; increasing the precision of the diagnosis in diseases presenting optic neuropathy as the main symptom&#46; In conclusion&#44; the findings obtained from magnetic resonance imaging are essential in the differential diagnosis of optic nerve diseases&#44; aiding in the localization and characterization of various pathologies affecting either the optic pathway alone or multiple levels of the central nervous system and thereby increasing diagnostic accuracy&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Este trabajo tiene como objetivo realizar una aproximaci&#243;n diagn&#243;stica de las posibles causas de neuropat&#237;a &#243;ptica&#44; enfoc&#225;ndose en los hallazgos radiol&#243;gicos de dicha entidad&#46; Se han identificado diferentes etiolog&#237;as&#44; como neuritis &#243;pticas inflamatorias y desmielinizantes&#44; enfermedades del desarrollo y hereditarias&#44; neurodegenerativas&#44; infecciosas&#44; postraum&#225;ticas&#44; isqu&#233;micas y tumorales&#46; La tomograf&#237;a de coherencia &#243;ptica y la resonancia magn&#233;tica desempe&#241;an un papel crucial en el diagn&#243;stico&#44; permitiendo distinguir los patrones de afectaci&#243;n y orientar el diagn&#243;stico diferencial&#46; Estos estudios son fundamentales para localizar y caracterizar las diferentes patolog&#237;as&#44; aumentando la precisi&#243;n del diagn&#243;stico en enfermedades que presentan neuropat&#237;a &#243;ptica como s&#237;ntoma principal&#46; En conclusi&#243;n&#44; los hallazgos obtenidos mediante resonancia magn&#233;tica son esenciales en el diagn&#243;stico diferencial de las posibles causas de neuropat&#237;a &#243;ptica&#44; ayudando en la localizaci&#243;n y caracterizaci&#243;n de diversas patolog&#237;as que afectan tanto a la v&#237;a &#243;ptica como a m&#250;ltiples niveles del sistema nervioso central&#44; mejorando as&#237; la precisi&#243;n diagn&#243;stica&#46;</p></span>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">45-year-old woman with clinical presentation indicative of acute bilateral optic neuritis&#46; A and B&#41; FLAIR sequences with fat suppression &#40;A&#41; axial &#40;B&#41; coronal&#58; signal hyperintensity and increased thickness of optic nerves &#40;arrows&#41;&#46; C and D&#41; T1 sequences with fat suppression and IV contrast &#40;C&#41; axial and &#40;D&#41; coronal&#58; enhancement of optic nerves &#40;arrows&#41; and blurring of the adjacent fat&#46; After the imaging tests and analysing the cerebrospinal fluid&#44; the patient was diagnosed with a neuromyelitis optica spectrum disorder&#46;</p>"
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">75-year-old man with diabetes and hypertension&#44; smoker&#44; who presented with symptoms that suggest left optic neuritis&#46; In the MRI&#44; altered signal in relation to the left optic nerve is observed&#44; with bilateral carotid atheroma&#44; findings that correspond to a non-arteritic anterior ischaemic optic neuropathy &#40;NA-AION&#41;&#46; FLAIR sequences in the axial &#40;from above&#41; and coronal &#40;from below&#41; planes are shown&#44; where the circle and arrow indicate the hyperintense signal relating to the left optic nerve in comparison with the opposite side&#46; The atheroma plaques in the carotid arteries are visible in the ultrasound images &#40;arrows&#41;&#46;</p>"
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          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Examples of optic neuritis secondary to multiple sclerosis in an MRI of the brain&#46; A and B&#41; 30-year-old woman with loss of visual acuity in left eye&#46; A&#58; Axial FLAIR sequence with signal alteration at left optic nerve &#40;arrow&#41;&#46; B&#58; Coronal FLAIR sequence with signal alteration at left optic nerve &#40;arrow&#41;&#46; C and D&#41; 28-year-old woman who attended the clinic for amaurosis with onset two days prior&#46; C&#58; Axial FLAIR sequence with signal alteration at left optic nerve &#40;arrow&#41;&#46; D&#58; left optic nerve enhancement &#40;arrow&#41; in coronal T1-weighted sequence with IV contrast&#46;</p>"
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          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">47-year-old woman with neuromyelitis optica spectrum disorder&#46; The brain MRI shows&#58; A&#41; Signal alteration relating to both optic nerves &#40;arrows&#41; with chiasm involvement in a coronal FLAIR sequence&#46; B&#41; Signal alteration relating to both optic nerves &#40;arrows&#41; with chiasm involvement in axial FLAIR sequence&#46; C&#41; Hyperintense spinal cord lesion at C2 level &#40;arrow&#41; in proton-density weighted sequence &#40;sagittal section&#41;&#46; D&#41; Hyperintense spinal cord lesion at C2 level &#40;arrow&#41; in T2-weighted sequence &#40;sagittal section&#41;&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">24-year-old patient with clinical presentation indicative of bilateral optic neuritis due to MOG antibody disease&#46; Brain MRI shows&#58; &#40;A&#41; bilateral enhancement of the nerve and optic nerve sheath &#40;arrows&#41; on the axial T1 with IV contrast&#59; &#40;B&#41; bilateral enhancement of the nerve and optic nerve sheath &#40;arrows&#41; on the coronal T1 with IV contrast&#59; &#40;C&#41; signal alteration of both optic nerves &#40;arrows&#41;&#44; compatible with bilateral optic neuritis on axial FLAIR sequence&#59; and &#40;D&#41; signal alteration of both optic nerves &#40;arrows&#41; compatible with bilateral optic neuritis on coronal FLAIR sequence&#46;</p>"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Summary of optic nerve involvement patterns in neuritis of demyelinating aetiology&#46; Axial FLAIR sequences are shown &#40;multiple sclerosis and optic neuromyelitis&#41; and axial T1 with IV contrast &#40;anti-MOG antibody&#41;&#46;</p>"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">48-year-old woman with clinical presentation indicative of retrobulbar optic neuritis at one week&#46; The MRI shows&#58; &#40;A&#41; enhancement of the left optic nerve in the T1-weighted image with IV contrast &#40;axial section&#41;&#59; &#40;B&#41; enhancement of the left optic nerve &#40;arrow&#41; in the T1-weighted image with IV contrast &#40;coronal section&#41;&#59; &#40;C&#41; signal alteration of both optic nerves &#40;arrows&#41;&#44; compatible with bilateral optic neuritis on axial FLAIR sequence&#59; and &#40;D&#41; signal alteration of both optic nerves &#40;arrows&#41; compatible with bilateral optic neuritis on coronal FLAIR sequence&#46; Oligoclonal bands&#44; anti-MOG antibodies and anti-AQ4 were all negative&#46; Angiotensin-converting enzyme &#40;ACE&#41; in the blood was 135 &#40;normal range 18&#8211;55&#41;&#46; The gallium SPECT scan revealed bilateral hilar adenopathies&#44; and finally neurosarcoidosis was diagnosed&#46;</p>"
        ]
      ]
      11 => array:8 [
        "identificador" => "fig0060"
        "etiqueta" => "Figure 12"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr12.jpeg"
            "Alto" => 1777
            "Ancho" => 1667
            "Tamanyo" => 221394
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        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0060"
            "detalle" => "Figure 1"
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">39-year-old woman who attended accident and emergency due to sudden left hemiparesis&#44; headache and fever&#44; complaining of mouth sores and painful genitalia for at least three years&#46; MRI of the brain was performed&#46; A&#41; Hyperintense signal in both optic nerves &#40;arrows&#41; on coronal FLAIR-SPIR sequence&#46; B&#41; Axial FLAIR sequence with signal alteration at right thalamus &#40;circle&#41;&#46; C&#41; Axial T1-weighted image with IV contrast shows right thalamus hypointense and not enhanced &#40;circle&#41;&#46; The patient was finally diagnosed with neuro-Beh&#231;et&#8217;s disease after ruling out infectious aetiology&#44; also compatible with clinical presentation&#46;</p>"
        ]
      ]
      12 => array:8 [
        "identificador" => "fig0065"
        "etiqueta" => "Figure 13"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr13.jpeg"
            "Alto" => 1313
            "Ancho" => 1667
            "Tamanyo" => 216168
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0065"
            "detalle" => "Figure 1"
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">29-year-old man with recurring episodes of vision loss and retroocular pain&#44; who was submitted to an MRI of the brain&#46; A&#41; Axial T2-GRE with thin slices where signal alteration at the optic chiasm is observed &#40;circle&#41;&#46; B&#41; Coronal FLAIR-SPIR sequence with signal alteration at both optic nerves &#40;arrows&#41;&#46; C&#41; Axial FLAIR sequence where atrophy of the optic nerves is observed &#40;arrows&#41;&#46; D&#41; Hyperintense signal at right optic nerve on coronal FLAIR-SPIR sequence&#46; The patient tested negative for anti-NMO antibodies and&#44; after ruling out other aetiologies&#44; including Leber&#8217;s optic neuropathy&#44; and in light of the rapid clinical improvement seen with corticosteroid treatment with worsening symptoms on withdrawal&#44; the patient was finally diagnosed with CRION&#46;</p>"
        ]
      ]
      13 => array:8 [
        "identificador" => "fig0070"
        "etiqueta" => "Figure 14"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr14.jpeg"
            "Alto" => 1813
            "Ancho" => 1667
            "Tamanyo" => 233170
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0070"
            "detalle" => "Figure 1"
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">40-year-old patient with neurolupus diagnosis who presented with&#58; A&#41; altered signal in the basal ganglia-thalamus region &#40;circle&#41; in the FLAIR sequence&#59; B&#41; that shows no enhancements on the T1 with IV contrast&#59; and C&#41; with hyperintensity of the signal in the left optic nerve &#40;circle&#41; compatible with optic neuritis in the axial FLAIR sequence&#46;</p>"
        ]
      ]
      14 => array:8 [
        "identificador" => "fig0075"
        "etiqueta" => "Figure 15"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr15.jpeg"
            "Alto" => 1598
            "Ancho" => 1550
            "Tamanyo" => 278486
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0075"
            "detalle" => "Figure 1"
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">64-year-old patient who experienced changes to their visual field 15&#8201;months after receiving radiotherapy&#46; A&#41; Altered signal and enhancement of optic chiasm &#40;arrow&#41; following IV contrast in sagittal FLAIR sequence&#46; B&#41; Altered signal and enhancement of both optic nerves &#40;arrows&#41; in axial T1 post-contrast&#46; C&#41; Altered signal of optic chiasm &#40;arrow&#41; in coronal FLAIR sequence&#46; Finally&#44; the patient was diagnosed with optic neuropathy secondary to radiotherapy considering the patient history and having ruled out other possible aetiologies&#46;</p>"
        ]
      ]
      15 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0080"
            "detalle" => "Table "
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          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ischaemic optic neuropathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ArteriticNon-arteritic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Inflammatory&#47;demyelinating optic neuritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Multiple sclerosisNeuromyelitis optica spectrum disorderMOG antibody disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Infections&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NeuroretinitisMeningitisSyphilis&#47;Lyme&#8217;s disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Genetics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Leber&#8217;s hereditary optic neuropathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Neoplasms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Optic nerve gliomaMeningiomaMetastasisLymphoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Compressive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AneurysmOrbital pseudotumourIdiopathic intracranial hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Toxic-metabolic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Trauma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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        "descripcion" => array:1 [
          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Summary table of the different aetiologies that can cause optic neuropathy&#46;</p>"
        ]
      ]
      16 => array:5 [
        "identificador" => "tb0001"
        "tipo" => "MULTIMEDIATEXTO"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "texto" => array:1 [
          "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Key points</span><p id="par0005" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8211;</span><p id="par0010" class="elsevierStylePara elsevierViewall">Optic neuropathy can be caused by multiple diseases and cause a wide range of clinical manifestations&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8211;</span><p id="par0015" class="elsevierStylePara elsevierViewall">MRI is the imaging technique of choice when assessing both the optic pathway and other central nervous system structures&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8211;</span><p id="par0020" class="elsevierStylePara elsevierViewall">Optic nerve disease is most easily identified in the retrobulbar intraorbital segment of the optic nerve&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8211;</span><p id="par0025" class="elsevierStylePara elsevierViewall">In the acute phase&#44; optic neuropathy on imaging can manifest as a swelling of the nerve with a high-intensity signal on T2-weighted images and post-contrast enhancement&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8211;</span><p id="par0030" class="elsevierStylePara elsevierViewall">Studies of optic neuropathy require a detailed medical history&#44; including patient demographics&#46; Furthermore&#44; in addition to imaging the optic pathway&#44; it is important to investigate whether there are other intracranial findings that may help in the differential diagnosis&#46;</p></li></ul></p></span></span>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:28 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Correlated size variations in human visual cortex&#44; lateral geniculate nucleus&#44; and optic tract"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "T&#46;J&#46; Andrews"
                            1 => "S&#46;D&#46; Halpern"
                            2 => "D&#46; Purves"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1523/JNEUROSCI.17-08-02859.1997"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Neurosci"
                        "fecha" => "1997"
                        "volumen" => "17"
                        "paginaInicial" => "2859"
                        "paginaFinal" => "2868"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9092607"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The optic nerve&#58; anatomy and pathology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "T de AL Freddi"
                            1 => "AC Ottaiano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Semin Ultrasound CT MRI"
                        "fecha" => "2022"
                        "volumen" => "43"
                        "paginaInicial" => "378"
                        "paginaFinal" => "388"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spectrum of optic neuropathies presenting in neuro-ophthalmology clinic at afio"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "U&#46; Ijaz"
                            1 => "A&#46; Habib"
                            2 => "H&#46;S&#46; Rathore"
                            3 => "M&#46;I&#46;S&#46; Khan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Pakistan Armed Forces Med J"
                        "fecha" => "2021"
                        "volumen" => "71"
                        "paginaInicial" => "112"
                        "paginaFinal" => "116"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Magnetic resonance imaging of intraocular optic nerve disorders&#58; review article"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46; Kanda"
                            1 => "A&#46; Miyazaki"
                            2 => "F&#46; Zeng"
                            3 => "Y&#46; Ueno"
                            4 => "K&#46; Sofue"
                            5 => "T&#46; Maeda"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.5114/pjr.2020.93364"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pol J Radiol"
                        "fecha" => "2020"
                        "volumen" => "85"
                        "paginaInicial" => "e67"
                        "paginaFinal" => "e81"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32467740"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Contrast-enhanced MRI in acute optic neuritis&#58; relationship to visual performance"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46;J&#46; Kupersmith"
                            1 => "T&#46; Alban"
                            2 => "B&#46; Zeiffer"
                            3 => "D&#46; Lefton"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Brain"
                        "fecha" => "2002"
                        "volumen" => "125 Pt 4"
                        "paginaInicial" => "812"
                        "paginaFinal" => "822"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The contribution of magnetic resonance imaging in the differential diagnosis of optic nerve damage"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A Gass"
                            1 => "IF Moseley"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Neurol Sci"
                        "fecha" => "2000"
                        "volumen" => "172 Suppl&#46; 1"
                        "paginaInicial" => "S17"
                        "paginaFinal" => "S22"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The fellow eye in NAION&#58; report from the ischemic optic neuropathy decompression trial follow-up study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46;J&#46; Newman"
                            1 => "R&#46; Scherer"
                            2 => "P&#46; Langenberg"
                            3 => "S&#46; Kelman"
                            4 => "S&#46; Feldon"
                            5 => "D&#46; Kaufman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0002-9394(02)01639-2"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Ophthalmol"
                        "fecha" => "2002"
                        "volumen" => "134"
                        "paginaInicial" => "317"
                        "paginaFinal" => "328"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12208242"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Arteritic anterior ischaemic optic neuropathy&#58; an update"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "V&#46; Bajpai"
                            1 => "S&#46; Madan"
                            2 => "S&#46; Beri"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/11206721211009447"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Ophthalmol"
                        "fecha" => "2021"
                        "volumen" => "31"
                        "paginaInicial" => "2818"
                        "paginaFinal" => "2827"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33892603"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
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Article information

ISSN: 21735107
Original language: English

DOI:10.1016/j.rxeng.2023.06.011

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