Multiple sclerosis and related disorders · 2026
Diagnostic challenges in suspected optic neuritis: a 5-year retrospective application of the 2022 international criteria.
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Dos Santos Dias Amanda Selvatici, Carneiro Rafael Paternò Castello Dias, Shimabukuro Eliana Tomomi, Prado Marcelle Sanjuan Ganem, Vital Samyra Melo, de Melo Elisa Matias Vieira, Mendes Maria Fernanda
Аннотация
BACKGROUND: Optic neuritis (ON) is a frequent cause of subacute visual loss, and distinguishing it from other causes of acute visual impairment remains challenging, particularly in non-specialized settings.
OBJECTIVE: To retrospectively apply the 2022 International Diagnostic Criteria to patients presenting with suspected optic neuritis, classify patients according to the diagnostic criteria, identify the most frequent alternative diagnoses, and assess access to paraclinical investigations.
METHODS: This retrospective observational study included patients presenting to the emergency department of a tertiary public hospital in São Paulo, Brazil, with an initial diagnosis of optic neuritis (ICD-10 H46) between 2019 and 2023. Clinical records were retrospectively reviewed, and patients were classified according to the 2022 International Diagnostic Criteria for optic neuritis. Clinical features, paraclinical investigations, and final diagnoses were analyzed.
RESULTS: A total of 224 patients with suspected optic neuritis were included. Of these, 99 (44.2%) fulfilled the criteria for definite ON and 7 (3.1%) were classified as possible ON. For the purposes of the present study, patients classified as either definite or possible ON comprised the ON cohort for subsequent analyses, whereas 118 (52.6%) did not fulfill the 2022 International Diagnostic Criteria for ON. Within the ON cohort, 41 patients (38.7%) had demyelinating disease, 2 (1.9%) had systemic inflammatory disease, and 2 (1.9%) had infectious etiologies, whereas 61 (57.5%) remained without a defined etiology. Access to paraclinical investigations was limited: cerebrospinal fluid oligoclonal bands were assessed in 13 patients (12.3%), AQP4-IgG in 42 (39.6%), and MOG-IgG in 19 (17.9%). Among patients who did not fulfill the 2022 International Diagnostic Criteria for ON, ophthalmologic diseases and other optic neuropathies were the most frequent alternative diagnoses among patients in whom an alternative diagnosis could be established.
CONCLUSION: More than half of cases initially suspected of optic neuritis did not fulfill the 2022 diagnostic criteria, and most cases in the ON cohort lacked a defined etiology. These findings highlight the need for improved adherence to standardized diagnostic frameworks and broader access to essential paraclinical investigations.
OBJECTIVE: To retrospectively apply the 2022 International Diagnostic Criteria to patients presenting with suspected optic neuritis, classify patients according to the diagnostic criteria, identify the most frequent alternative diagnoses, and assess access to paraclinical investigations.
METHODS: This retrospective observational study included patients presenting to the emergency department of a tertiary public hospital in São Paulo, Brazil, with an initial diagnosis of optic neuritis (ICD-10 H46) between 2019 and 2023. Clinical records were retrospectively reviewed, and patients were classified according to the 2022 International Diagnostic Criteria for optic neuritis. Clinical features, paraclinical investigations, and final diagnoses were analyzed.
RESULTS: A total of 224 patients with suspected optic neuritis were included. Of these, 99 (44.2%) fulfilled the criteria for definite ON and 7 (3.1%) were classified as possible ON. For the purposes of the present study, patients classified as either definite or possible ON comprised the ON cohort for subsequent analyses, whereas 118 (52.6%) did not fulfill the 2022 International Diagnostic Criteria for ON. Within the ON cohort, 41 patients (38.7%) had demyelinating disease, 2 (1.9%) had systemic inflammatory disease, and 2 (1.9%) had infectious etiologies, whereas 61 (57.5%) remained without a defined etiology. Access to paraclinical investigations was limited: cerebrospinal fluid oligoclonal bands were assessed in 13 patients (12.3%), AQP4-IgG in 42 (39.6%), and MOG-IgG in 19 (17.9%). Among patients who did not fulfill the 2022 International Diagnostic Criteria for ON, ophthalmologic diseases and other optic neuropathies were the most frequent alternative diagnoses among patients in whom an alternative diagnosis could be established.
CONCLUSION: More than half of cases initially suspected of optic neuritis did not fulfill the 2022 diagnostic criteria, and most cases in the ON cohort lacked a defined etiology. These findings highlight the need for improved adherence to standardized diagnostic frameworks and broader access to essential paraclinical investigations.