LAUSR

This study by Shah et al. demonstrated that asymptomatic optic nerve enhancement could occur in optic neuritis (ON) patients.1 For multiple sclerosis, silent lesions on MRI have diagnostic and prognostic values and are used in disease monitoring.2 However, the frequency of new silent lesions (including asymptomatic ON, myelitis, and brain lesions) and their association with future relapse in aquaporin-4 antibody neuromyelitis optica spectrum disorder remain unclear.1,3,4 The authors indicated that optic nerve enhancement at the site of prior attacks with shorter lesion length presumably represented intermittent blood-brain barrier breakdown; however, recurrent ON cannot be completely ruled out, especially when it has been a long time since the last attack. New asymptomatic lesions in 2 scans could be subclinical relapses and often require acute therapeutic intervention.