A 28-year-old woman has acute painful optic neuritis. Visual field shows a cecocentral scotoma. MRI of the brain reveals 2 white matter lesions at the corpus callosum perpendicular to its surface (Dawson's fingers). The MOST appropriate immediate management is:
- A Intravenous methylprednisolone 1 g/day for 3 days followed by oral prednisone taper ✓
- B Oral prednisone 1 mg/kg/day for 2 weeks
- C Plasmapheresis
- D Observation without treatment
Correct answer: A. Intravenous methylprednisolone 1 g/day for 3 days followed by oral prednisone taper
Explanation
The Optic Neuritis Treatment Trial (ONTT) established that IV methylprednisolone 250 mg qid (1 g/day) for 3 days followed by oral prednisone taper speeds visual recovery but does not improve final visual outcome. Importantly, the trial showed oral prednisone alone increased the rate of recurrence and was not recommended as monotherapy. MRI evidence of multiple demyelinating lesions (Dawson's fingers at corpus callosum) indicates high risk for MS conversion, making early immunotherapy with disease-modifying therapy appropriate after the acute episode.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.