Neurology & Neurosurgery

In the theoretical case of a 24-year-old woman presenting to a hospital’s emergency department with blurred vision, some of the hallmark features pointed to a diagnosis of early multiple sclerosis (MS). Suggestive clinical findings also included an age of onset between 20 and 50 years, eye pain that worsened with eye movements, and visual loss occurring over several days to two weeks.

Steven Galetta, MD, and colleagues have used optic coherence tomography (OCT) to help establish a key imaging criterion for diagnosing an optic neuropathy—and in the proper clinical setting, for diagnosing optic neuritis. The potential early manifestation of MS, they found, could be reliably identified through an asymmetry of five or more microns in the thickness between right and left optic nerves, which normally measure between 90 and 100 microns apiece.

Researchers who identify the signs of optic neuritis must consider five main causes for the inflammation. Beyond MS, neuromyelitis optica and myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease can present similarly. Systemic infections such as syphilis or Lyme disease can likewise impact the optic nerve while the inflammation sometimes fails to associate with any established cause.

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