Good Morning #MedTwitter #neurotwitter #MedEd #Neurotwt #Neuroresidents #NeuroOphthalmology #Neuroimmunology #twittorial. Let's have a quick review on #OpticNeuritis and #NMO - Grab a #coffee and let's Start!
1/ Classic #opticneuritis is characterized by a sub-acute loss of vision in one Eye, with central #scotoma, pain on #eyemovement, positive #RAPD
- Fundus exam is usually normal
- Age range 15-45 years
- Fundus exam is usually normal
- Age range 15-45 years
2/Talking about #MOGAntibodies:
- More frequent in #pediatric population, Associated with #ADEM
- #MOG IgG serum titers depend on disease activity and is mainly from extrathecal origin, enters #CNS from systemic circulation and reaches CSF through passive diffusion or broken #BBB
- More frequent in #pediatric population, Associated with #ADEM
- #MOG IgG serum titers depend on disease activity and is mainly from extrathecal origin, enters #CNS from systemic circulation and reaches CSF through passive diffusion or broken #BBB
3/ What are the Characteristics of #MOG #opticneuritis (ON):
- Optic disk edema (86%)
- MRI perineural enhancement (50%), with longitudinal extensive involvement (80%).
- 30-50% recurrence of #ON
- 37% bilateral ON
ncbi.nlm.nih.gov/pmc/articles/P…
- Optic disk edema (86%)
- MRI perineural enhancement (50%), with longitudinal extensive involvement (80%).
- 30-50% recurrence of #ON
- 37% bilateral ON
ncbi.nlm.nih.gov/pmc/articles/P…
4/ 40% had #opticneuritis + Other #neurological symptoms:
22% AQP4-IgG seronegative #NMOSD
18% ADEM in children
Most have significant visual recovery
36% #transversemyelitis, assoc or subsequent
10-20% of patients with NMOSD are negative for AQP4-IgG
22% AQP4-IgG seronegative #NMOSD
18% ADEM in children
Most have significant visual recovery
36% #transversemyelitis, assoc or subsequent
10-20% of patients with NMOSD are negative for AQP4-IgG
Treatment:
IV #methylprednisolone during acute attack
Should also consider #PLEX or #IVIG
Maintenance on low-dose oral #prednisone for longer (up to 3 months) and #immunosuppressants: #mycophenolate #azathioprine or #rituximab
IV #methylprednisolone during acute attack
Should also consider #PLEX or #IVIG
Maintenance on low-dose oral #prednisone for longer (up to 3 months) and #immunosuppressants: #mycophenolate #azathioprine or #rituximab
6/ Differential diagnosis of bilateral #opticneuritis:
#demyelinating (#MS, NMO, MOG), #autoimmune (#sarcoid #SLE), Infectious (Brucelosis,#Lyme, Ehrlichiosis, Tb, syphilis), Viral (#HIV, #VZV), Malignancy, #Leukemia, optic nerve sheath meningioma.
#demyelinating (#MS, NMO, MOG), #autoimmune (#sarcoid #SLE), Infectious (Brucelosis,#Lyme, Ehrlichiosis, Tb, syphilis), Viral (#HIV, #VZV), Malignancy, #Leukemia, optic nerve sheath meningioma.
7/#MOG in the age groups:
- Children > ADEM
- Adults 20-45 yo > unilateral #opticneuritis
- Adults >45 yo > bilateral optic neuritis
Younger age at first attack is associated with increased risk of permanent vision loss
pubmed.ncbi.nlm.nih.gov/29136091/
- Children > ADEM
- Adults 20-45 yo > unilateral #opticneuritis
- Adults >45 yo > bilateral optic neuritis
Younger age at first attack is associated with increased risk of permanent vision loss
pubmed.ncbi.nlm.nih.gov/29136091/
8/ Lastly, when thinking of another differential of #opticneuritis... Keep in mind #wasp Associated optic neuritis!
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