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A 10 year old girl develops pain around her right eye and, two days later, vision loss in that eye. She has no other symptoms, has had no other unusual illnesses, takes no medications, and has no pertinent family history. Visual function is abnormal in the right eye, with an afferent pupil defect in that eye. Visual function is normal in the left eye. The examination of the optic fundus is normal in both eyes. This MRI shows orbit views. The brain MRI shows some scattered non-enhancing cerebral white matter high signal T2/FLAIR patches. The neurological examination is normal.
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The clinical and imaging features strongly suggest myelin oligodendrocyte glycoprotein (MOG) antibody-associated optic neuritis. The orbit imaging shows longitudinally-extensive enhancement and thickening of the optic nerve dura, which is characteristic of MOG optic neuritis. The scattered high T2/FLAIR cerebral white matter signal abnormalities could reflect acute disseminated encephalitis, which has been associated with the MOG antibody. The aquaporin-4 antibody is found in neuromyelitis optica (NMO, Devic disease), which also displays longitudinal enhancement along the course of the optic nerve, but within the nerve substance itself, rather than within its dural covering. Cerebrospinal fluid NMO and MOG are not helpful in diagnosis. In this patient, if the MOG antibody were normal, you would have to consider a wide variety of infectious and autoimmune conditions, demanding a thorough evaluation.
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Correct!
The clinical and imaging features strongly suggest myelin oligodendrocyte glycoprotein (MOG) antibody-associated optic neuritis. The orbit imaging shows longitudinally-extensive enhancement and thickening of the optic nerve dura, which is characteristic of MOG optic neuritis. The scattered high T2/FLAIR cerebral white matter signal abnormalities could reflect acute disseminated encephalitis, which has been associated with the MOG antibody. The aquaporin-4 antibody is found in neuromyelitis optica (NMO, Devic disease), which also displays longitudinal enhancement along the course of the optic nerve, but within the nerve substance itself, rather than within its dural covering. Cerebrospinal fluid NMO and MOG are not helpful in diagnosis. In this patient, if the MOG antibody were normal, you would have to consider a wide variety of infectious and autoimmune conditions, demanding a thorough evaluation.