Decoding the diagnostic dilemma of optic neuritis in children: Case series

Optic neuritis (ON) occurs in approximately one-fourth of children presenting with an initial demyelinating event. It presents different clinical characteristics than those found in adults and is associated with different prognosis and recurrence rates. Pediatric ON has a wide differential, including clinically isolated syndrome, multiple sclerosis (MS), myelin oligodendrocyte glycoprotein (MOG), neuromyelitis optica spectrum disorder (NMOSD), infectious causes, and para-infectious causes. Knowledge regarding clinical presentation, associated diseases, therapy, and outcomes in ON in children has grown over the past decade. In addition to the classical techniques such as magnetic resonance imaging (MRI), current tendencies of diagnosis include optical coherence tomography (OCT), which is useful to show a thinning of the retinal fiber layer (RFL) after the inflammatory episode. Regarding the management of these patients, short-term intravenous steroid dosages seem to be the best option to treat acute attacks. This article describes 12 pediatric cases presenting clinically with ON. We aim to characterize ON into different etiopathogenetic mechanisms with attention to associated syndromes and assess the effect of prompt administration of high-dose intravenous steroids on the disease course.