@article {1559573, title = {A multi-center case series of sarcoid optic neuropathy}, journal = {J Neurol Sci}, year = {2020}, month = {2020 Dec 19}, pages = {117282}, abstract = {OBJECTIVE: The diagnosis of sarcoid optic neuropathy is time-sensitive, as delayed treatment risks irreversible vision loss. We sought to analyze its characteristics and outcomes. METHODS: We performed a multi-center retrospective study of sarcoid optic neuropathy among 5 USA medical centers. Inclusion criteria were: 1) clinical optic neuropathy; 2) optic nerve/sheath enhancement on neuroimaging; 3) pathological confirmation of systemic or nervous system sarcoidosis. RESULTS: Fifty-one patients were included. The median onset age of sarcoid optic neuropathy was 50\ years (range, 17-70\ years) and 71\% were female. The median visual acuity at nadir in the most affected eye was 20/80 (range, 20/20 to no-light-perception). Thirty-four of 50 (68\%) patients had radiologic evidence of other nervous system involvement and 20 (39\%) patients had symptoms/signs of other cranial nerve dysfunction. Cerebrospinal fluid analysis revealed an elevated white blood cell count in 22 of 31 (71\%) patients (median: 14/μL; range: 1-643/μL). Pathologic confirmation of sarcoidosis was by biopsy of systemic/pulmonary site, 34 (67\%); optic nerve/sheath, 9 (18\%); or other nervous system region, 8 (16\%). Forty patients improved with treatment (78\%), 98\% receiving corticosteroids and 65\% receiving steroid-sparing immunosuppressants, yet 11/46 patients (24\%) had a visual acuity of 20/200 or worse at last follow-up. CONCLUSIONS: Sarcoid optic neuropathy frequently occurs with other clinical and radiologic abnormalities caused by neurosarcoidosis and diagnostic confirmation occasionally requires optic nerve/sheath biopsy. Improvement with treatment is common but most patients have some residual visual disability. Improved recognition and a more expeditious diagnosis and treatment may spare patients from permanent vision loss.}, issn = {1878-5883}, doi = {10.1016/j.jns.2020.117282}, author = {Webb, Lauren M and Chen, John J and Aksamit, Allen J and Bhattacharyya, Shamik and Chwalisz, Bart K and Balaban, Denis and Manzano, Giovanna S and Ali, Ahya S and Lord, Jennifer and Clardy, Stacey L and Samudralwar, Rohini D and Mao-Draayer, Yang and Garrity, James A and Bhatti, M Tariq and Turner, Lindsey E and Flanagan, Eoin P} }