Skill Checkup: Suboptimally Treated Relapsing-Remitting Multiple Sclerosis (RRMS)

Christopher Luzzio, MD

Disclosures

September 24, 2021

In addition to an ophthalmologic examination, orbital and brain MRI with or without gadolinium should be done to establish a diagnosis of optic neuritis. Use of fat saturation techniques facilitates visualization of gadolinium enhancement of the optic nerve and is the optimal imaging technique for visualizing inflammation of the optic nerve. MRI of the spinal cord should be performed in patients with suspected neuromyelitis optica.

In most patients with typical optic neuritis, lumbar puncture and laboratory studies are not necessary; in atypical cases, particularly those involving children, bilateral optic neuritis, or those in which systemic or infectious diseases are a concern, careful examination using appropriate laboratory studies is crucial to establishing the correct diagnosis and treatment regimen.

Compared with MRI, CT provides no prognostic or treatment-altering information for classic optic neuritis.

In this case, MRI of the brain with and without contrast was performed. Results showed new white-matter T2 hyperintensities as well as scattered foci of enhancement consistent with active and new demyelination, superimposed on a background of older MS lesions. MRI of the orbits revealed that bilateral optic nerves were normal and symmetrical in size and signal.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....