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Optic neuritis – MRI for MS — RACP Paediatrics MCQ

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ModerateNeurologyOptic neuritis – MRI for MSRACP Paediatrics

A 14-year-old presents with unilateral optic neuritis (painful visual loss, RAPD, optic disc swelling). MRI brain shows periventricular white matter lesions with some enhancing and some non-enhancing. What is the most important investigation to assess for CNS demyelination?

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Correct answer: E — MRI brain with contrast

Optic neuritis with periventricular white matter lesions (some enhancing = acute, some non-enhancing = old) raises concern for multiple sclerosis. MRI brain with gadolinium contrast is the key investigation – it demonstrates dissemination in space and time per the McDonald criteria. Aquaporin-4 and MOG antibodies should also be tested.

Reference: RCH Melbourne – 2023 – Demyelination CPG; RACP Paediatric Curriculum – Neurology