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Optic chiasm, optic tract and deep white demyelination: an unusual distribution of myelin oligodendrocyte glycoprotein-associated demyelination (MOGAD), case report and review of literature
  1. Adeline Lasrado1,
  2. Goura Chattannavar2,
  3. Virender Sachdeva3 and
  4. Ramesh Kekunnaya2
  1. 1Fellow LVPEI, Standard Chartered LVPEI Academy of Eye Care Education, LV Prasad Eye Institute, Hyderabad, Telangana, India
  2. 2Child Sight Institute, Jasti V Ramanamma Children's Eye Care Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India
  3. 3Paediatric Ophthalmology, Strabismus and Neuro-ophthalmology, LV Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
  1. Correspondence to Dr Goura Chattannavar, Strabismus, Pediatric and Neuro-ophthalmology, LV Prasad Eye Institute, Hyderabad, Telangana, India; drgourachattannavar{at}


A preschool girl presented with sudden-onset bilateral painless loss of vision from 2 days prior. Child’s examination showed light perception vision, sluggishly reacting pupils, otherwise normal anterior segment, healthy optic disc and retina in both eyes. MRI of brain and orbit with contrast revealed thickened left part of the optic chiasm with contrast enhancement extending proximally to bilateral optic tract and hyperintensities in the left thalamus and periventricular white mater. Considering the topographical distribution of lesions in the brain, neuromyelitis optica spectrum disorder was suspected. The child was started on intravenous methylprednisolone followed by tapering oral steroids. Serological testing was positive for myelin oligodendrocyte glycoprotein (MOG) and negative for aquaporin-4 antibodies. This case represents an unusual case of MOG associated demyelination disorder where the distribution of lesions showed chiasmal involvement along with optic tract, thalamus and deep white mater lesions.

  • Immunology
  • Neuroimaging
  • Neuroopthalmology
  • Visual pathway

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  • Contributors AL: manuscript writing, editing GC: Idea of report, manuscript writing, editing, revising VS: supervision and revision. RK: Supervision and revision.

  • Funding This study was funded by Hyderabad Eye Research Foundation (LEC-BHR-R-06-22-909).

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.