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Updated: Aug 22, 2025

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Atypical Optic Neuritis: The Potential Red Flags.

Pawan T Ojha1, Prachi P Barvalia1, Rakesh Singh1

  • 1Department of Neurology, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India.

Neurology India
|November 10, 2022
PubMed
Summary

Identifying red flags for atypical optic neuritis (ON) is crucial. Key indicators include extreme age onset, multiple attacks, severe vision loss, and non-MS disease signs, guiding prompt, effective treatment.

Keywords:
AtypicalMOG-associatedinflammatory optic neuritisneuromyelitis optica

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Area of Science:

  • Ophthalmology
  • Neuroimmunology

Background:

  • Optic nerve inflammation (optic neuritis) has diverse causes, necessitating distinct management approaches.
  • Differentiating typical from atypical optic neuritis is essential for appropriate patient care.

Purpose of the Study:

  • To identify clinical and radiological red flags distinguishing typical from atypical optic neuritis (ON).

Main Methods:

  • Prospective study of 66 patients (100 eyes) with immune-mediated ON.
  • Exclusion of non-immune causes and analysis of clinico-radiological features, investigations, therapy, and outcomes.

Main Results:

  • Atypical ON presented with extremes of age, bilateral/severe vision loss, early disc pallor, multiple attacks, and non-MS neurological/imaging findings.
  • Neuromyelitis optica (NMO) and MOG-associated ON (MOG-ON) were common atypical forms.
  • Systemic involvement and poorer outcomes were more frequent in atypical ON, often despite aggressive immunosuppression.

Conclusions:

  • Red flags for atypical ON include age extremes, multiple attacks, severe vision loss, early disc pallor, non-MS disease indicators, systemic involvement, and poor steroid response.
  • Prompt identification of these red flags can guide escalated therapy and improve patient outcomes.