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Now eye enjoyed an important question addressed at #EAN2020. Good to think about when you are called to ED for #opticneuritis. Let’s think about it together. Let’s focus on #clinicaldiagnosismaking #meded #medstudenttwitter #medtwitter #neurologyresident @WNGtweets @EANeurology
How do you tell if it’s optic neuritis or not? #painless #unilateral #altitudinal -means top half or bottom half of the field - vision loss more likely to be non-arteritic AION. Any other red flags less likely to be optic neuritis?
Now if it’s #painful it’s more likely #opticneuritis - but what sort? Bilateral vision loss and painful, think #MOG. Unilateral severe vision loss more than pain, think #Aquaporin4. MRI orbits show longitudinal extensive optic nerve enhancement in both. So MRI orbits for clues.
Remember that some vasculitis can cause bilateral visual loss too - think #sarcoidosis and #Sjögren’s. If it’s unilateral with a headache and muscle aches weeks prior to painless visual loss - think #giantcellarteritis. What serological markers might you consider?
Aye aye. What about #metamorphopsia? That’s a very useful sign - that means when straight lines look wavy - macula is affected so think of neuro-retinitis. Think infection if there’s flu like symptoms preceding. Think Bartonella, Syphilis, Lyme, HIV.
There you have it. Quick 5 questions - Painful? Bilateral? Early/severe visual loss? Wavy lines? Systemic symptoms? And I’ve hinted at the #MRI and #serologies you can consider.@DxRxEdu #meded #medstudenttwitter #medtwitter #neurologyresident #AcademicTwitter #doubledoc
Remember if you think it’s typical optical neuritis, rule out #multiplesclerosis -think #CSF studies and MRI brain and whole spine. More pearls on #opticneuritis? @RachelSalasMD @Tracey1milligan @MonicaDhakar @MarcusVPinto @EricLawson90 @AaronLBerkowitz @MadSattinJ @WNGtweets
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