optic neuritis

And today I wanted to talk about an article that helps us distinguish between the causes of acute optic neuropathy, especially when that patient initially presents to the clinic or hospital.

Although MOG-associated optic neuritis and non-arteritic anterior ischemic optic neuropathy, or NAILN, have really distinct underlying pathophysiology, they have a really considerable clinical overlap, especially at the index admission, leading to some really challenging diagnostic scenarios.

And I think we've discussed in the podcast, this error of GLP-1s and their association with NION makes this discussion even more challenging.

So there was an article published in N2 called Acute Optic Neuropathy in Older Adults, Differentiating Between MOG, Optic Neuritis, and Non-Arteritic Antierischemic Optic Neuropathy that gives some clinical pearls to help us differentiate between these two entities.

The authors used an international multi-center case-controlled study utilizing data from tertiary neuro-ophthalmology centers to compare unilateral MOG-associated optic neuritis cases to NAOM in older patients to see what diagnostic clues are essential to the correct diagnosis.

One point that's worth emphasizing is they chose MOG instead of multiple sclerosis or other related disorders as MOG commonly presents with optic disc edema, and it's universally present in NAION cases, unusual and other causes of inflammatory optic neuritis.

Some key elements that stood out from my read of this article among the patients with MOG associated optic neuritis, pain and headaches were really common.

though I was struck by the number of patients in the ischemic group that had headache that was represented by almost 20% having some nonspecific temporal or other headache, creating, again, some initial confusion.