Childhood Optic Neuritis Differential Diagnoses

Updated: Nov 30, 2015
  • Author: Martha P Schatz, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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Diagnostic Considerations

Neuromyelitis optica

Formal diagnostic criteria for neuromyelitis optica are as follows: absolute criteria and one major supportive criterion or two minor supportive criteria.

Absolute criteria include the following:

  • Optic neuritis
  • Acute myelitis
  • No clinical disease outside the optic nerves and spinal cord

Major supportive criteria include the following:

  • Negative brain MRI at disease onset
  • Spinal cord MRI with T2 signal abnormality extending over 3 or more vertebral segments
  • Cerebrospinal fluid (CSF) pleocytosis greater than 50 WBC/mm 3 or greater than 5 neutrophils/mm 3

Minor supportive criteria include the following:

  • Bilateral optic neuritis
  • Severe optic neuritis with fixed visual acuity worse than 20/200 in at least one eye
  • Severe, fixed, attack-related weakness in one or more limbs

Since there may be a delay between the optic neuritis and the myelitis, and since the treatment will be different, suspicion for neuromyelitis optica should prompt laboratory study for NMO (neuromyelitis optica) antibody.

Other possible diagnoses

Leber hereditary optic neuropathy

Papilledema from intracranial hypertension

Optic nerve glioma

Craniopharyngioma or pituitary adenoma