Optic Neuritis: MS vs AQP4-NMOSD vs MOGAD

Optic neuritis is not a single disease phenotype. Recognizing the clinical and MRI patterns can provide important clues to the underlying disorder.

🔹 MS: usually unilateral, painful, short-segment involvement with generally good visual recovery.
🔹 AQP4-NMOSD: severe, often posterior/chiasmal involvement, associated with LETM/area postrema syndrome and poorer visual recovery.
🔹 MOGAD: often bilateral, prominent disc edema, anterior/long-segment involvement with perineural enhancement, typically steroid-responsive but prone to relapse with rapid taper.

Clinical pearl: Bilateral, severe, recurrent, steroid-dependent, or otherwise atypical optic neuritis should prompt consideration of AQP4-IgG and MOG-IgG testing.

Information provided by: Javed Anees, Neurology/Internal Medicine/Neuro-Rehabilitation, Tirur, Kerala, India

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