53 yo female (rn) s/p optic neuritis. mri shows "flair & t2 images show scattered punctate areas of increased signal w/i periventricular white matter"?

MS or not MS?: This kind of case will either be diagnosed as optic neuritis or as MS. Since the T2 / FLAIR lesions are small (i.e. punctate) it is a bit uncertain. If they were a bit larger, the diagnosis would be MS. For smaller lesions, perhaps it is not. A spinal tap may help to sort out the answer. The answer is important, so that future relapses can be prevented. Think about vitamin D.