Differential Diagnosis for Sudden Loss of Vision in a Patient with Relapsing-Remitting Multiple Sclerosis

• Single Most Likely Diagnosis
  • Optic Neuritis: This is a common manifestation of multiple sclerosis (MS), especially in patients with relapsing-remitting MS. Sudden loss of vision, often accompanied by pain on eye movement, is a hallmark of optic neuritis, making it the most likely diagnosis in this context.
• Other Likely Diagnoses
  • Ischemic Optic Neuropathy: Although less common in younger patients, ischemic optic neuropathy can cause sudden vision loss and should be considered, especially if the patient has other risk factors such as hypertension or diabetes.
  • Neuromyelitis Optica (NMO) Spectrum Disorder: Patients with NMO can experience optic neuritis similar to MS, but it tends to be more severe. Differentiating between MS and NMO is crucial due to differences in treatment and prognosis.
• Do Not Miss Diagnoses
  • Central Retinal Artery Occlusion: This condition requires immediate medical attention to restore vision. It presents with sudden, painless loss of vision and is a medical emergency.
  • Giant Cell Arteritis: Although more common in older adults, giant cell arteritis can cause sudden vision loss and is a medical emergency due to the risk of bilateral blindness if not promptly treated.
• Rare Diagnoses
  • Leber's Hereditary Optic Neuropathy: A rare mitochondrial inherited disorder that can cause sudden vision loss, typically in young adult males. It's less likely but should be considered in the appropriate demographic.
  • Syphilis-Related Optic Neuritis: In the context of a patient with multiple sclerosis, this would be an unusual diagnosis, but syphilis can cause a wide range of neurological symptoms, including optic neuritis, especially in patients with untreated or late-stage infection.
  • Sarcoidosis: This autoimmune disease can affect the optic nerve and cause vision loss. While rare, it's an important consideration due to its potential for multi-system involvement and the need for specific treatment.