MOGAD optic neuritis after mild head/orbital trauma in six children

Abstract

Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a potential cause of optic neuritis (ON). Its triggers and etiologies are not completely understood. We describe a novel clinical observation in six young patients with MOGAD-ON in the setting of strikingly parallel histories of mild head/orbital trauma. This is a single-center retrospective case series of six young patients and age-matched isolated MOGAD-ON controls. We present data both individually (de-identified, only the six trauma-associated cases) and in aggregate. Averages are presented as the arithmetic mean +/− SEM. 6/27 patients with MOGAD-ON, (3/6 female), between 8 and 18 years old presented with ON 5.5 days after mild head trauma. Four patients developed ON ipsilateral to their unilateral head trauma while two developed bilateral ON following midline head trauma. All patients tested positive for serum anti-MOG antibodies upon ON workup. They all received intravenous corticosteroids with rapid improvement in symptoms (5.5 weeks to full visual recovery) and none have since relapsed. No other patients with MOGAD-ON experienced preceding head trauma, and all patients in the control group were asked about trauma upon assessment of the history. Head trauma may serve as an inciting event in the presentation and diagnosis of MOGAD-ON. This novel observation provides a potential pathophysiologic mechanism independent of infectious triggers, although we cannot determine if these patients were already predisposed towards MOGAD-ON.