Differential Diagnosis for Multiple Sclerosis-related Optic Neuritis

Area of Science:

• Ophthalmology
• Neurology
• Immunology

Background:

• Multiple sclerosis-related optic neuritis (MS-ON) presents diagnostic challenges.
• Accurate differential diagnosis is crucial for appropriate patient management.
• Understanding clinical features aids in distinguishing MS-ON from other optic neuropathies.

Purpose of the Study:

• To analyze the clinical features and primary causes of MS-ON.
• To provide evidence supporting the differential diagnosis of MS-ON.
• To identify common misdiagnoses of MS-ON.

Main Methods:

• Clinical data from 527 patients diagnosed with MS-ON were retrospectively analyzed.
• Diagnostic methods included visual acuity, optometry, visual field testing, slit-lamp microscopy, indirect ophthalmoscopy, optical coherence tomography (OCT), and magnetic resonance imaging (MRI).
• Autoimmune antibodies and Aquaporin-4 (AQP-4) levels were assessed via venous blood sampling.

Main Results:

• Neuromyelitis optica-related optic neuritis (NMO-ON) was diagnosed in 59 cases, Sjogren's syndrome-related optic neuropathy in 27, tumors in 22, and anterior ischemic optic neuropathy in 21.
• Among 168 MS-ON patients with optic nerve MRI, lesions were <15 mm in 53.57%, 15-30 mm in 45.24%, and >30 mm in 1.19%.
• MS-ON was frequently misdiagnosed with NMO-ON and Sjogren's syndrome.

Conclusions:

• Multiple sclerosis-related optic neuritis (MS-ON) is commonly misdiagnosed, particularly with neuromyelitis optica-related optic neuritis (NMO-ON) and Sjogren's syndrome.
• Distinguishing MS-ON from other optic neuropathies, tumors, and ischemic optic neuropathy is essential.
• Clinical feature analysis and advanced imaging aid in accurate MS-ON diagnosis.