Case 6: Image question 3

Questions

1. Where is the abnormality located?

Answer

2. Describe the abnormality using appropriate terminology.

Answer

3. List the differential diagnosis for the abnormality.

• Demyelinating Disease: Enhancement of the nerve without nerve enlargement (in light of the patient's clinical symptoms) is highly suggestive of optic neuritis. Optic neuritis may be secondary to multiple sclerosis, other demyelinating disesaes such as Neuromyelitis Optica (NMO) and other inflammatory conditions.
• Tumor: The lack of enlargement of the nerve makes tumor less likely. Tumor of the optic nerve is often seen in conjunction with a clinical history of Neurofibromatosis type I.
• Infection: Infection can certainly cause optic nerve enhancement and should be considered on the differential.
• Granulomatous Disease: Granulomatous diseases such as neurosarcoidosis can cause optic nerve enhancement.

Questions (continued)

4. How can you narrow the differential?

Answer