Teaching NeuroImage: Rapid Identification of Infectious Optic Neuritis by Next-Generation Sequencing

Abstract

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Precision Terminology

“…The term "atypical optic neuritis" has been used to describe optic neuropathies whose clinical behavior differs from idiopathic or MS-associated optic neuritis, with features that may include optic nerve sheath enhancement, rapid response to corticosteroids, relapsing course after steroid discontinuation, severe disc edema, or concomitant retinal involvement, and this term has been stamped promiscuously on multiple optic neuropathy pathophysiologies, including infectious (e.g., Bartonella and spirochete), ischemic (e.g., vasculitis and nonarteritic anterior ischemic optic neuropathy [NAION]), inflammatory (e.g., sarcoid), inherited (e.g., Leber hereditary optic neuropathy), infiltrative (e.g., neoplastic), intracranial pressure-related (papilledema), or toxic (e.g., ethambutol) etiologies (in addition to certain retinopathies) attesting to the nonspecificity of this meaningless term. [2][3][4] Accordingly, we propose elimination of the term "atypical optic neuritis" as: 1. The "itis" modifier is often erroneous (e.g., infiltrative, inherited, infectious, or ischemic optic neuropathies without a primarily inflammatory pathophysiology).…”