MOG-IgG positive optic neuritis is generally seen in children or young adults, classically peaking around the third decade with an equal preponderance between females and males. Thus, despite the clinical overlap between these three entities, it is crucial to appreciate that they are separate diseases with differing pathophysiology, clinical course, and most importantly, different treatments. Most importantly, recent advances have categorized MOG-IgG associated disorders (MOGADs) as distict from both multiple sclerosis and aquaporin-4 (AQP4)-IgG-positive associated disorders. However, recent studies have found optic neuritis (ON) to be its predominant phenotype in both the pediatric and adult populations. Myelin oligodendrocyte glycoprotein (MOG)-IgG was initially thought of as a marker of multiple sclerosis and acute disseminated encephalomyelitis (ADEM) in children. Marked elevation and distortion of the optic nerve head leading to artifactual thickening of the retinal nerve fiber layer and ganglion cell layer OU.īiomarkers have changed the paradigm for characterizing and correctly diagnosing CNS inflammatory and demyelinating diseases.Optical Coherence Tomography (Figure 4).Left eye (left image) demonstrates complete loss of the I2e isopter, marked constriction of the I3e with small island remaining nasally, and a dense cecocentral scotoma with complete loss of the V4e.Right eye (right image) demonstrates complete loss of the I1e isopter, marked constriction of the I2e with only a small island remaining nasally, and a dense cecocentral scotoma with complete loss of the V4e.Myelin Oligodendrocyte Glycoprotein (MOG) Ab: positive 1:1000.Neuromyeltis optica (NMO) /Aquaporin-4-IgG Ab: negative.Meningitis/encephalitis panel: negative for bacterial and viral agents.Pink, hazy, no xanthochromia, total protein: 22, glucose: 73, RBC: 1000, total nucleated cells: 8 (0 neutrophils, 7 lymphocytes), opening pressure 26cm Lumbar puncture w/ cytology and opening pressure:.Bartonella henselae IgG/IgM titer: negative.Anti-neutrophil cytoplasmic antibody: negative.Anti-double stranded DNA quantitative: 6 (ref 0-4 IU/mL).Anti-double stranded DNA qualitative: indeterminant.MRI cervical, thoracic, lumbar spine: normal.(Figure 2) MRI brain and orbits w/ and w/o contrast: enhancement and enlargement of intraorbital segments of optic nerves, left > right.Intracranial mass with obstructive hydrocephalus and compression of anterior visual pathway.Cup-to-disc: no cup noted in either optic nerve.OS: Grade II disc edema, no pallor, no hemorrhages, no exudates.OD: Grade I disc edema, no pallor, no hemorrhages, no exudates.Iris: Normal architecture, pharmacologically dilated OU.Deferred in the setting of poor visual acuity.OS: 7.5mm in dim light, constricting to 6.5mm with bright light minimally reactive secondary to pharmacologic dilation prior to arrivalĬonfrontational Visual Fields (count fingers).OD: 7.5mm in dim light, constricting to 6.5mm with bright light minimally reactive secondary to pharmacologic dilation prior to arrival.
#ANTI MOG SYNDROME FULL#
No other recent illnesses or changes in her health were reported by mom. Treated urinary tract infection several weeks ago.No notable stressors at home or at school.Great aunt – possible similar symptoms at a young age.
The patient’s mom reported no cats or other animals in the household, no recent travel, no recent outdoor activities such as hiking, and no recent reported tick bites. She denied nausea, vomiting, ringing in her ears, diplopia, or episodes of transient vision loss Additionally, headaches were present which worsened when lying down. The child’s mother stated that her daughter began having difficulty distinguishing colors prior to the onset of her vision loss and described colors as appearing “dim.” The child also endorsed mild achiness of the left eye with subsequent achiness of the right eye both associated with the onset of blurry vision. Chief Complaint: Progressive vision loss left > rightĪ 9-year old female was referred to the University of Iowa to undergo additional evaluation for profound vision loss with “optic disc swelling.” The child presented with her mother and related progressive blurry vision of both eyes that began 4 days prior to evaluation.
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