Table 1 Prior cases of MOGAD associated with increased intracranial pressure mimicking IIH compared to the case presented
PresentingCase | Patient(1) from“Case of.atypical Anti-MOG Syndrome” [1] | Patient(2) from “Case of atypical Anti-MOG Syndrome” [1] | “Atypical MOG Presenting with isolated elevate ICP” [2] | “Caseof MOG associated with serious retinal detachment” [3] | Patient(1) from “MOG masquerading as IIH” [4] | Patient(2) from “MOG masquerading as IIH” [4] | Patient(3) from “MOG masquerading as IIH” [4] | Patient(4) from “MOG masquerading as IIH” [4] | Patient(5) from “MOG masquerading as IIH” [4] | CaseAverages from MOG Clinical Characteristics [5] | |
|---|---|---|---|---|---|---|---|---|---|---|---|
Gender | Female. | Female. | Male. | Male. | Female. | Female. | Male. | Female. | Male. | Female. | 57% Female. |
BMI | 35.44 kg/m2 | Obese | NA | Obese | NA | 38 kg/m2 | 32 kg/m2 | 41 kg/m2 | 32 kg/m2 | 23 kg/m2 | NA |
Visual Acuity | HA OD and 20/60 in OS. | 20/400 OD CF 2 OS. | HA OD. RAPD OD. | Normal. | 20/50 OD 20/40 OS. | Mildly decreased. | Mildly decreased. | 20/60 bilaterally. | Unable to obtain. | 20/60 OD. RAPD OD. | 20/30 Bilateral. |
Visual Fields | Diffusely depressed OD and a temporal hemianopia superimposed on inferior altitudinal field defect OS. | Inferior and supero-temporal visual field defects OS. | NA | Normal. | Mild enlargement of the physiological blind spot OS. | Bilaterally enlarged blind spots. | Bilaterally enlarged blind spots. | Nasal step defect in one eye and a normal field in the other. | NA | NA | NA |
OCT | OCT 37 OD 40 OS with diffuse optic atrophy. Edema in macula. | NA | NA | NA | OCT revealed subretinal fluid in macula bilaterally. | Thickened peripapillary retinal nerve fiber layer (RNFL) bilaterally. | Thickened RNFL bilaterally. | Thickened RNFL bilaterally (RE 140 μm, LE 172 μm). | Thickened RNFL bilaterally. | NA | NA |
Fundoscopic Findings | Intraretinal cystic change in the inner retina corresponding with optic atrophy. | Relative red desaturation OS. Bilateral papilledema. | Disk edema OD. | Bilateral papilledema. | Bilateral disk edema. | Bilateral disc edema. | Bilateral disc edema. | Bilateral disc edema. | Bilateral disc edema. | Bilateral disc edema. | 36/42. Present in 86% of cases. |
Symptoms | Painless progressive peripheral vision loss. | Bifrontal headaches, photophobia, blurry vision. | Headache, neck pain, neck stiffness, photophobia, nausea, vomiting. | Headache, blurry vision, nausea, and vomiting. | 1-week history of blurred vision. | Headaches, blurred vision. | Headaches, blurred vision. | Headaches, blurred vision. | Headaches, blurred vision. | Headaches, blurred vision. | Pain (86%) Recurrent optic neuritis (10%) Monophasic optic neuritis (10%) ADEM (18%) NMSOD-like phenotype (22%) |
MRI findings | ONSE. | Bilateral swelling and increased FLAIR with enhancement of the optic nerves. An enhancing pituitary mass. | Inflammation of the right optic nerve. Non-specific bilateral periventricular white matter changes. | Signs of elevated ICP, dilation of optic nerve sheaths, flattening of posterior globes, and a partially empty sella. | ONSE. | Hyperintense signal in both optic nerves with gadolinium enhancement of the right optic nerve. | ONSE. | ONSE. | ONSE. | Enhancement of the right optic nerve. Several hyperintense periventricular and subcortical white matter lesions. | Perineural enhancement: 50% Length involved more than half: 80% Orbital portion involved: 92% Intracranial portion involved: 72% Chiasm involved: 12% |
CSF Opening Pressure and Analysis | Markedly elevated. Normal constituents | 29 cmH2O Lymphocytic Pleocytosis | 24 cmH2O Polymorphonuclear Pleocytosis | 52 cmH2O Lymphocytic Pleocytosis | NA | 26 cmH2O Normal constituents | 33 cmH2O Normal constituents | 23 cmH2O Normal constituents | 24 cmH2O Normal constituents | 35 cmH2O Normal | 44% had pleocytosis |
MOG Titer | 1:100 | 1:100 | Positive. | 1:10,000 | 1:512 | Positive. | Positive. | Positive. | Positive. | Positive. | 100* |