Leber’s Hereditary Optic Neuropathy with Oligoclonal Bandsin the Serum Regarded as Multiple Sclerosis – a Case Report

Czech version

Authors: L. Čechová ¹; A. Bartoš ^1,2; J. Bartošová ³; D. Doležil ¹
Authors‘ workplace: Univerzita Karlova 3. LF a FN Královské Vinohrady, Neurologická klinika, Praha, 2Psychiatrické centrum Praha, 3Univerzita Karlova 3. LF a FN Královské Vinohrady, Oftalmologická klinika, Praha ¹
Published in: Cesk Slov Neurol N 2009; 72/105(2): 155-158
Category: Case Report

Overview

Visi on deteri orated in an 18- ye ar-old man witho ut peri ocular pain during one week in the left eye first and in the right eye two months later. Ne urological findings were otherwise normal. Magnetic resonance imaging (MRI) of the brain was normal and there were high signals within optic nerves and chi asma. Oligoclonal IgG bands were repe atedly detected in the cerebrospinal fluid. As a result, the disorder was considered to be multiple sclerosis. The visi on failed to improve during one- ye ar follow‑up and no other impairment appe ared. The results of a uxili ary investigati ons were not in agreement with the atypical clinical co urse of the dise ase and normal MRI of the brain. We considered other di agnoses due to this discrepancy. Anti‑aqu aporin antibodi es did not support ne uromyelitis optica (Devic dise ase). Finally, the mitochondri al DNA mutati on confirmed Leber hereditary optic ne uropathy (LHON). The correct di agnosis was achi eved after bro ad interdisciplinary co operati on including foreign laboratory. This case illustrates the misle ading role of oligoclonal bands in cerebrospinal fluid and sho uld incre ase general knowledge about LHON in physici ans.

Key words:
multiple sclerosis – Leber hereditary optic ne uropathy – oligoclonal IgG bands – cerebrospinal fluid

Sources

1. Vaněk I, Bartošová J, Bartoš A. Ne uro oftalmologi e. In: Kuchynka P et al. Oční lékařství. Praha: Grada 2007: 501– 554.

2. Man PY, Turnbull DM, Chinnery PF. Leber hereditary optic ne uropathy. J Med Genet 2002; 39(3): 162– 169.

3. Oguchi Y. Past, present, and future in Leber’s hereditary optic ne uropathy – a revi ew. Jpn J Ophthalmol 2002; 46(3): 352– 353.

4. Newman NJ. Hereditary optic ne uropathi es: from the mitochondri a to the optic nerve. Am J Ophthalmol 2005; 140(3): 517– 523.

5. Teive HA, Tro i ano AR, Raskin S, Werneck LC. Leber’s hereditary optic ne uropathy – case report and literature revi ew. Sao Pa ulo Med J 2004; 122(6): 276– 279.

6. Vanopdenbosch L, Dubo is B, D’Ho oghe MB, Meire F,Carton H. Mitochondri al mutati ons of Leber’s hereditary optic ne uropathy: a risk factor for multiple sclerosis. J Ne urol 2000; 247(7): 535– 543.

7. Konrádová V, Zeman J, Stratilová L, Heřmanská, Všetička I, Mišovicová N et al. Leberova hereditární ne uropati e optiku (LHON). Čas Lék čes 1999; 138(18): 565– 568.

8. Bartoš A. Klinické využití protilátek u roztro ušené sklerózy. Cesk Slov Ne urol N 2008; 71/ 104(1): 26– 33.

9. Jung S, Fassbender K. Oligoklonale IgG- Banden im Liquor bei einem Jungen mit Leber’scher hereditärer Opticusatrophi e ohne Anhalt für Multiple Sklerose – Risikofaktor für eine LHON- MS oder „häufigeres Phänomen“? Akt Ne urol 2006; 33: 1055.

10. Bartos A, Pitha J. Opsoclonus- myoclonus- dysequilibri um syndrome: cytological and immunological dynamics in the seri al cerebrospinal fluid in two pati ents. J Ne urol 2003; 250(12): 1420– 1425.

11. Reiber H, Peter JB. Cerebrospinal fluid analysis: dise ase‑related data patterns and evalu ati on programs. J Ne urol Sci 2001; 184(2): 101– 122.