Misc
My Eyes!
Bring It On, Baby
Crunch The Numbers
Treatments
100
This cause of optic neuropathy is associated with perineural tissue in 50% of cases
MOGAD
100
True/False: Based on the Optic Neuritis Treatment Trial, treating with high dose steroids improves visual acuity during acute episode
False: Improves speed of recovery
100
Out of MS, MOG, and NMO, this condition has a higher predilection for worse prognosis/more disabling lasting symptoms
NMO
100
A patient with optic neuritis and a normal MRI has this percentage change of developing MS in 5 years? (range of 5%)
15%
MRI with normal CSF -- 96% NPV
100
True/False: ONTT found that 1 mg/kg high dose steroids treatment was non-inferior to 1g/day of steroid for optic neuritis
False: 1mg/kg was clearly found to be inferior compared with IV 1g methylprednisolone (can consider very high dose at home at times)
200
This is the frequency of MOGAD being a monophasic disease
50%
200
Worsening blurry vision with dyschromatopsia alongside one clinical symptom and physical exam finding is highly suspicious of optic neuritis
Clinical: pain with eye movements (90%)
Physical exam: RAPD
200
This cause of optic neuropathy is commonly accompanied by the triad of upper respiratory tract, lower respiratory tract, and renal involvement
Granulomatosis with Polyangiitis
Ocular findings occur 50% of the time
200
A patient with optic neuritis with 3 or more lesions on MRI have a what percent risk of MS at 5 years (Range of 5%)
50%
200
This CD20 inhibitor is commonly used for NMO maintenance therapy
Rituximab
300
MOG associated optic neuritis is commonly associated with this physical exam finding
Optic edema (75%)
300
NMO and MOG can be differentiated based on their involvement of the optic nerve. Explain these findings.
1. NMO - posterior optic nerve involvement/chiasm/radiation
2. MOG - anterior segment of optic nerve. Can present with optic edema
Both longitudinally extensive of optic nerve (>50%)
300
In a patient with serum-proven MOGAD who had MRI findings of optic nerve enhancement and supratentoral white matter hyperintensities. On repeat MRI imaging, what would you commonly see?
Resolution of enhancement and hyperintensities
300
What is the prevalence of oligoclonal bands in MS, NMO, and MOG (10% range)
MS: 85%
NMO: 15%
MOG: 10%
300
Describe acute treatment for NMO suspected/confirmed attacks (1 +- 1)
High dose steroids often in conjunction with PLEX
Time to treatment correlates with lasting symptoms/deficits
When might consider PLEX for unilateral optic neuritis?
400
MOGAD is associated with these clinical phenotypes (4)
1. Optic neuritis
2. Longitudinally Extensive Myelitis
3. Acute Disseminated encephalomyelitis (majority of MOG in kids is ADEM)
4. Cortical Encephalitis
400
These four infectious etiologies are the most common infectious etiologies for optic neuritis
1. Bartonella (Cat Scratch -- occurs 2-4 weeks after initial infection; 10% of cases)
2. Spirochetes (Syphilis/Lyme)
3. Fungal disease (Mucormycosis/Aspergillosis)
4. TB
400
This autoimmune etiology cause of optic neuropathy is associated with seizures, myelitis, and this characteristic imaging finding
GFAP; Linear perivascular enhancement
400
This is the specificity of MOG antibodies at high titers (>1:100) (nearest 10%)
99%
400
These agents are C5 complement inhibitors used for treated of NMO-SD
Eculizumab, ravulizumab
500
These are the 6 clinical phenotypes of NMO-SD
1. Optic neuritis
2. Acute myelitis
3. Area postrema syndrome
4. Acute brainstem syndrome
5. Symptomatic narcolepsy/dialeptic syndrome
6. Symptomatic cerebral syndrome + NMO brain lesions
500
This is the rate of bilateral optic neuritis in MS, NMO, and MOG (10% range)
MS: Rare
NMO: 20-30%
MOG: 50%
500
This antibody is associated with small cell carcinoma or thymoma, optic neuropathy, and basal ganglionitis
CRMP-5
Also associated with myelitis, cerebellar dysfunction, peripheral neuropathy
500
Sensitivity and specificity of serum NMO markers (AQP-4 cell based assay) (range 10%)
Sensitivity:76%
Specificity:99%
500
These MS medications can worsen NMO (3) (Bonus for MOA)
1. Beta interferons
2. Fingolimod
3. Natalizumab