Case 6: What to order

Clinical History

HPI: 23 year old woman with right eye pain, visual loss, paresthesias.

Questions

1. What is your clinical differential diagnosis?

Answer

2. What scan would you order next?

• Since the patient is having symptoms referable to the optic nerve and multiple sclerosis is high on the differential, the best imaging test to order is an MRI of the orbits and brain without and with contrast. CT is not great for evaluating the optic nerve for intrinsic abnormalities or at evaluating the brain for demyelination.