Research Article| Volume 345, ISSUE 1-2, P209-212, October 15, 2014

Download started.


Longitudinally extensive optic neuritis in neuromyelitis optica spectrum disorder


      • Distinguishing between causes of optic neuritis is of paramount importance.
      • Optic nerve enhancement distinguishes neuromyelitis optica from multiple sclerosis.
      • Enhancement greater than 40 mm can be called longitudinally extensive optic neuritis.



      Neuomyelitis optica, sarcoid, and multiple sclerosis can all cause optic neuritis. Further means of distinguishing the causes of optic neuritis among these etiologies would be valuable for the clinician.


      This is a retrospective, cohort study from a single university based hospital and neuro-ophthalmology clinic. Blinded interpretation of orbit MRIs was performed on patients with acute optic neuritis from multiple sclerosis (n = 25), sarcoid (n = 5) and neuromyelitis optica spectrum disorder (n = 6).


      A length of >40 mm anterior visual pathway enhancement distinguished neuromyelitis optica spectrum disorder from multiple sclerosis (p = 0.0376). No statistically significant differences were found for presence of pain or papillitis, however there was a trend for bilateral involvement and chiasmal involvement in neuromyelitis optica spectrum disorder compared to multiple sclerosis.


      In acute optic neuritis, enhancing anterior visual pathway lesion length >40 mm helps differentiate neuromyelitis optica spectrum disorder from multiple sclerosis. This degree of involvement can be considered longitudinally extensive optic neuritis. Further characterization is necessary as this degree of enhancement occurs in other clinical syndromes besides neuromyelitis optica.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the Neurological Sciences
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Grossman R.I.
        • Gonzalez-Scarano F.
        • Atlas S.W.
        • Galetta S.
        • Silberberg D.H.
        Multiple sclerosis: gadolinium enhancement in MR imaging.
        Radiology. 1986; 161: 721-725
        • Devic E.
        Myelite subaigue compliquee de nevrite optique.
        Bull Med. 1894; 8: 1033-1034
        • Devic E.
        Myelite aigue dorse-lombaire avec nevrite optique, autopsie.
        Congress Francais Medicine (Premiere Session, Lyon). 1. 1895: 434-439
        • Wingerchuk D.M.
        • Lennon V.A.
        • Pittock S.J.
        • Lucchinetti C.F.
        • Weinshenker B.G.
        Revised diagnostic criteria for neuromyelitis optica.
        Neurology. 2006; 66: 1485-1489
        • Levin M.H.
        • Bennett J.L.
        • Verkman A.S.
        Optic neuritis in neuromyelitis optica.
        Prog Retin Eye Res. 2013; 36: 159-171
        • Khanna S.
        • Sharma A.
        • Huecker J.
        • Gordon M.
        • Naismith R.T.
        • Van Stavern G.P.
        Magnetic resonance imaging of optic neuritis in patients with neuromyelitis optica versus multiple sclerosis.
        J Neuroophthalmol. Sep 2012; 32: 216-220
        • Lim Y.
        • Pyun S.Y.
        • Lim H.T.
        • Jeong I.H.
        • Kim K.
        First-ever optic neuritis: distinguishing subsequent neuromyelitis optica from multiple sclerosis.
        Neurol Sci. 2014 May; 35: 781-783
        • Storoni M.
        • Davagnanam I.
        • Radon M.
        • Siddiqui A.
        • Plant G.T.
        Distinguishing optic neuritis in neuromyelitis optica spectrum disease from multiple sclerosis: a novel magnetic resonance imaging scoring system.
        J Neuroophthalmol. 2013; 33: 123-127
        • Kawasaki A.
        • Purvin V.A.
        Idiopathic chiasmal neuritis.
        Arch Ophthalmol. 2009; 127: 76-81
        • Koczman J.J.
        • Rouleau J.
        • Gaunt M.
        • Kardon R.H.
        • Wall M.
        • Lee A.G.
        Neuro-ophthalmic sarcoidosis: the University of Iowa experience.
        Semin Ophthalmol. 2008; 23: 157-168
        • Wingerchuk D.M.
        • Weinshenker B.G.
        Neuromyelitis optica.
        Curr Treat Options Neurol. 2008; 10: 55-66
        • Lana-Peixoto M.A.
        • Callegaro D.
        The expanded spectrum of neuromyelitis optica: evidences for a new definition.
        Arq Neuropsiquiatr. 2012; 70: 807-813
        • Takahashi T.
        • Miyazawa I.
        • Misu T.
        • Takano R.
        • Nakashima I.
        • Fujihara K.
        • et al.
        Intractable hiccup and nausea in neuromyelitis optica with anti-aquaporin-4 antibody: a herald of acute exacerbations.
        J Neurol Neurosurg Psychiatry. 2008; 79: 1075-1078
        • Sato D.K.
        • Callegaro D.
        • Lana-Peixoto M.A.
        • Waters P.J.
        • de Haidar Jorge F.M.
        • Takahashi T.
        Distinction between MOG antibody-positive and AQP4 antibody-positive NMO spectrum disorders.
        Neurology. 2014; 82: 474-481
        • Pittock S.J.
        • Lennon V.A.
        • Krecke K.
        • Wingerchuk D.M.
        • Lucchinetti C.F.
        • Weinshenker B.G.
        Brain abnormalities in neuromyelitis optica.
        Arch Neurol. 2006; 63: 390-396
        • Weinshenker B.G.
        • Wingerchuk D.M.
        • Vukusic S.
        • et al.
        Neuromyelitis optica IgG predicts relapse after longitudinally extensive transverse myelitis.
        Ann Neurol. 2006; 59: 566-569
        • Galetta S.
        • Cornblath W.T.
        Should most patients with optic neuritis be tested for neuromyelitis optica antibodies and should this affect their treatment?.
        J Neuro-Ophthalmol. 2010; 30: 376-379
        • Kupersmith M.J.
        • Alban T.
        • Zeiffer B.
        • Lefton D.
        Contrast-enhanced MRI in acute optic neuritis: relationship to visual performance.
        Brain. 2002; 125: 812-822