What is the role of lab tests in the workup of optic neuritis in multiple sclerosis (MS)?

Updated: Feb 21, 2019
  • Author: Fiona Costello, MD, FRCP; Chief Editor: Hampton Roy, Sr, MD  more...
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Answer

Answer

In the setting of typical optic neuritis, laboratory studies are not generally useful in facilitating diagnosis. [18] However, additional investigations can be helpful in detecting potential mimics, such as NMO-associated optic neuritis, lupus-related optic neuropathy, and syphilitic optic nerve injury.

Specific clinical features should prompt consideration of these alternate diagnoses. Therefore, ancillary investigations should be selected based on the history and physical examination findings and may include any of the following:

  • Complete blood count (CBC) to evaluate for features of anemia, leukemia, or leukocytosis
  • Serum vitamin B-12 and folate levels (eg, bilateral central scotoma)
  • Lyme titers (eg, endemic area, tick exposure, rash of erythema chronica migrans)
  • Tuberculin skin testing, chest radiography, or QuantiFERON-TB testing (eg, tuberculosis [TB] exposure, endemic area)
  • Fluorescent treponemal antibody (FTA) testing (eg, syphilis serology) or nontreponemal testing (eg, Venereal Disease Research Laboratories [VDRL] testing or rapid plasma reagin [RPR] testing)
  • Antinuclear antibody (eg, systemic lupus erythematosus)
  • HIV testing (eg, high-risk patients)
  • Angiotensin-converting enzyme (ACE) level, lysozyme (eg, sarcoidosis)
  • Erythrocyte sedimentation rate (eg, inflammatory disorders)
  • Serum NMO antibody IgG (anti–aquaporin-4 [AQP4] antibody) testing
  • Serum anti-MOG antibody testing [21]
  • Mononuclear spot test (monospot test) (infectious mononucleosis due to Epstein-Barr virus)

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