Neurology & Neurosurgery

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Expert Perspectives

How One of the Nation’s Largest Neurology Residency Programs Equips Trainees for Success

Program director Dr. Arielle Kurzweil highlights the program’s innovative curriculum and approach to training.

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Complex Case Spotlight

New Push for Optic Neuritis as the Fifth Lesion Site in Multiple Sclerosis

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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.

Research has established five main clinical findings that point to optic neuritis in patients.
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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.

Imaging by OCT from an actual case shows an asymmetry of 21 microns between a patient’s right and left optic nerves: 75 versus 96 microns, respectively—a potential early sign of optic nerve impairment and multiple sclerosis.
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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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Differential diagnosis of optic neuritis must distinguish among multiple potential causes.
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