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

Christopher Luzzio, MD


January 26, 2022

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.


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