Optic neuritis — SCE Neurology MCQ

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HardMSOptic neuritisSCE Neurology

A 26-year-old has recurrent painful visual loss, severe optic-disc swelling and longitudinal enhancement involving the optic chiasm. A previous attack affected the opposite eye and brain MRI lacks typical multiple-sclerosis lesions. What is the most useful antibody investigation?

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Correct answer: B — Paired serum AQP4-IgG and MOG-IgG cell-based assays

The best answer is “Paired serum AQP4-IgG and MOG-IgG cell-based assays”. Recurrent, severe, long-segment or chiasmal optic neuritis is atypical for conventional MS and should prompt evaluation for AQP4-NMOSD and MOGAD with reliable serum cell-based assays because diagnosis changes relapse prevention. “Serum acetylcholine-receptor and MuSK antibody testing” is less appropriate because junctional antibodies assess fatigable weakness rather than optic-nerve inflammation “CSF JC-virus PCR using an ultrasensitive laboratory assay” is less appropriate because PML does not typically present as recurrent painful optic neuritis “NOTCH3 sequencing for a hereditary arteriopathy” is less appropriate because CADASIL is a hereditary small-vessel arteriopathy “Skeletal-muscle biopsy with inflammatory staining” is less appropriate because muscle tissue cannot identify CNS demyelinating antibodies

Reference: Optic neuritis: a practical guide. https://pn.bmj.com/content/18/5/358 NEMOS recommendations: attack therapy and long-term management of NMOSD. https://pmc.ncbi.nlm.nih.gov/articles/PMC10770020/ International MOGAD diagnostic criteria. https://pubmed.ncbi.nlm.nih.gov/36706773/