| Clinical |
- Rapid onset to nadir (within 6 hours), consider ischemia
- Progression beyond 1 month or progressive course between clinical attacks (consider MS, sarcoid)
- Severe residual deficit with poor recovery favors AQP4-NMOSD, ischemia
|
| Laboratory |
- Presence of oligoclonal bands <15% in MOGAD versus 85% in MS
|
| Imaging |
| Orbit |
- Absence of enhancement of optic nerve (favors noninflammatory [eg, ischemic, genetic, nutritional])
- No reduction of enhancement in follow-up 3 or more months later (favors tumor)
|
| Brain |
- T2 lesions in inferior temporal pole, ovoid periventricular, perpendicular to the ventricle (favors MS)
- T1 hypointensities (favors MS)
- Persistence of most T2-hyperintense lesions on follow-up MRI beyond 6 months (favors MS; most MOGAD T2-lesions resolve completely)
- Development of new T2-lesions between clinical attacks (favors MS)
- Persistence of enhancement beyond 3 months (consider tumor, sarcoid, other)
|
| Spinal cord |
- One or more T2-lesions <3 vertebral segments and located in the cord periphery without concurrent T2-lesion extending ≥3 vertebral segments (favors MS)
- Persistence of cord T2-hyperintense lesions over time, particularly those located peripherally in cord (favors MS; most MOGAD lesions resolve completely)
- Development of new T2-lesions between attacks (favors MS)
- Persistent enhancement beyond 3 months (consider tumor, sarcoid, other)
|
