Numbness, Tingling, or Weakness in Extremities Across Optic Neuritis Conditions
Yes, numbness, tingling, or weakness in extremities can occur in MS-associated optic neuritis, NMOSD, and SLE, but is not a feature of isolated optic neuritis or MOGAD-associated optic neuritis alone.
MS-Associated Optic Neuritis
- Extremity symptoms are common when optic neuritis occurs with concurrent myelopathy in MS, presenting as numbness, tingling, or weakness due to spinal cord demyelinating lesions 1.
- Patients with MS-associated optic neuritis may develop transverse myelitis with altered sensation, pain, muscle weakness, or atrophy as part of their demyelinating disease 2.
- The combination of optic neuritis with myelopathy requires immediate high-dose IV methylprednisolone 1000 mg/day for 3 days, as concurrent spinal cord involvement produces these extremity symptoms 1.
- Extensive spinal cord lesions (>3 segments) with reduced muscle strength or sphincter dysfunction may require plasma exchange if steroids fail 1.
NMOSD (Neuromyelitis Optica Spectrum Disorder)
- NMOSD characteristically presents with longitudinally extensive transverse myelitis (LETM) causing bilateral lower limb weakness, numbness, and urinary retention 3, 4.
- The typical initial manifestations in adult NMOSD patients are optic neuritis and myelitis, with myelitis producing prominent extremity symptoms 5.
- NMOSD patients commonly present with acute urinary retention, bilateral lower limb weakness, and sensory disturbances due to spinal cord involvement extending multiple segments 3.
- LETM in NMOSD extends over >3 vertebral segments and produces severe motor and sensory deficits in the extremities 2, 4.
SLE (Systemic Lupus Erythematosus)
- SLE can cause peripheral neuropathy (2-3%) presenting with altered sensation, pain, muscle weakness, or atrophy in extremities 2.
- SLE-related peripheral nervous system disorders include polyneuropathy, mononeuropathy (single or multiplex), and acute inflammatory demyelinating polyradiculoneuropathy 2.
- When SLE causes transverse myelitis concurrent with optic neuritis, patients develop extremity weakness and sensory changes 2.
- Co-existing transverse myelitis with optic neuritis in SLE suggests an underlying inflammatory basis requiring pulse IV methylprednisolone combined with IV cyclophosphamide 2.
MOGAD (MOG Antibody-Associated Disease)
- MOGAD-associated optic neuritis alone does not typically cause extremity symptoms, as the disease primarily affects the optic nerves 2, 5.
- However, MOGAD can present with myelitis in addition to optic neuritis, which would then produce extremity symptoms 5.
- Short spinal cord lesions occur in approximately 44-52% of MOG-EM patients over the disease course, though LETM is also common 2.
Isolated Optic Neuritis
- Isolated optic neuritis without concurrent CNS involvement does not cause numbness, tingling, or weakness in extremities 6.
- The optic nerve inflammation occurs along the nerve itself and produces only visual symptoms, periocular pain, and photophobia 6.
Critical Diagnostic Considerations
- When extremity symptoms accompany optic neuritis, immediately obtain MRI of brain and complete spine with contrast to identify myelitis 1, 3.
- Test for AQP4-IgG and MOG-IgG antibodies when LETM (>3 segments) is present with optic neuritis, as this dramatically changes treatment approach 1, 5.
- Nerve conduction studies and electromyography can identify peripheral neuropathy patterns in SLE patients with extremity symptoms 2.
- The presence of extremity symptoms with optic neuritis indicates multifocal CNS involvement requiring more aggressive immunosuppression than isolated optic neuritis 2, 1.