Pediatric optic neuritis: a diagnostic challenge Pediatric optic neuritis: a diagnostic challenge

Neuritis óptica pediátrica: un desafio diagnóstico

Background: Optic neuritis requires challenging diagnosis and management, it can present in isolation or associated with inflammatory disorders, being part of the clinic of up to 25% of pediatric acute demyelinating syndromes. The estimated annual incidence of pediatric ON is 0.2 per 100,000 children, with a female preponderance and a mean age of presentation of 9 to 11 years.

Summary: We present the case of a 12-year-old patient with an acute picture of diplopia, left eye pain; Without relevant antecedents, in whom was found paralysis of the VI left pair and brain magnetic resonance (RMc) with enhancement in the optic nerve, beginning treatment with intravenous corticosteroid therapy, after ruling out infectious pathologies, with satisfactory evolution.

Conclusions: In the spectrum of optic neuritis, knowledge of its different etiologies is important, since the treatment and prognosis depend on the cause.

Key words: Pediatric optic neuritis, myelitis, aquaporin-4 antibody, multiple sclerosis, myelin oligodendrocyte glycoprotein antibody.

1. Chang MY, Pineles SL. Pediatric Optic Neuritis. Semin Pediatr Neurol. 2017;24(2):122–8. doi: 10.1016/j.spen.2017.04.004
2. Waldman AT, Stull LB, Galetta SL, Balcer LJ, Liu GT. Pediatric optic neuritis and risk of multiple sclerosis: Meta-analysis of observational studies. J AAPOS. 2010;15(5):441–6. doi: 10.1016/j.jaapos.2011.05.020
3. Gise RA, Heidary G. Update on Pediatric Optic Neuritis. Curr Neurol Neurosci Rep. 2020;20(3):4. doi: 10.1007/s11910-020-1024-x
4. Chitnis T, Ness J, Krupp L, Waubant E, Hunt T, Cody Olsen MsS, et al. Clinical features of neuromyelitis optica in children. Am Acad Neurol. 2015;86:245–252. doi: 10.1212/WNL.0000000000002283
5. Chen JJ, Pittock SJ, Flanagan EP, Lennon VA, Bhatti MT. Optic neuritis in the era of biomarkers. Surv Ophthalmol. 2020;65(1):12–7. doi: 10.1016/j.survophthal.2019.08.001
6. Borchert M, Liu GT, Pineles S, Waldman AT. Pediatric Optic Neuritis: What Is New. J Neuroophthalmol. 2017;37(Suppl 1):S14–22. doi: 10.1097/WNO.0000000000000551
7. Rodrigues G, Oliveira LM, da Costa BK, Apostolos-Pereira SL, Callegaro D, Fujihara K, et al. MOG-IgG-associated optic neuritis, encephalitis, and myelitis: Lessons learned from neuromyelitis optica spectrum disorder. Front Neurol. 2018;9:217. doi: 10.3389/fneur.2018.00217
8. Brenton JN, Banwell BL. Therapeutic Approach to the Management of Pediatric Demyelinating Disease: Multiple Sclerosis and Acute Disseminated Encephalomyelitis. Neurotherapeutics. 2016;13(1):84–95. doi: 10.1007/s13311-015-0396-0
9. Hardy BDI, Banwell BL. Pediatric-Onset Multiple Sclerosis. Pract Neurol. 2019:71–5.
10. Wingerchuk DM, Banwell B, Bennett JL, Cabre P, Carroll W, Chitnis T, et al. International consensus diagnostic criteria for neuromyelitis optica spectrum disorders. Neurology. 2015;85(2):177–89. doi: 10.1212/WNL.0000000000001729
11. Toosy AT, Mason DF, Miller DH. Optic neuritis. Lancet Neurol. 2014;13(1):83–99. doi: 10.1016/S1474-4422(13)70259-X
12. Rostasy K, Mader S, Schanda K, Huppke P, Gärtner J, Kraus V, et al. Anti-myelin oligodendrocyte glycoprotein antibodies in pediatric patients with optic neuritis. Arch Neurol. 2012;69(6):752–6. doi:10.1001/archneurol.2011.2956
13. De Seze J, Kremer L, Collongues N. Neuromyelitis optica spectrum disorder (NMOSD): A new concept. Rev Neurol (Paris). 2016;172(4–5):256–62. doi: 10.1016/j.neurol.2016.03.003