Is this MS or Anterior Ischemic Optic Neuropathy (AION)?

Here is My Question:
I am a 66 year old male recently diagnosed with MS with 1 documented relapse. Given my age, a history of Celiac disease, hypothyroidism, and recent pulmonary embolisms 2 months before 1st presentation of optic neuritis, what would be the appropriate MS med to prevent
relapses & progression of MS? I need to continue taking Coumadin & Synthroid as well as Lisinopril.
Thank you!

Answer:
Call me a skeptic, but I get concerned when I hear about a 66 year old man newly diagnosed with MS, especially when it appears to be of a relapsing type. I certainly do see individuals in this age group with a new diagnosis of MS, but this diagnosis requires additional assurance and diagnostic evaluations for various reasons in your age group. For instance you have a diagnosis of Celiac disease which is associated with the development of non specific white matter lesions on MRI in the absence of MS. You have also recently experienced pulmonary embolisms which are very usual in individuals who are not ill or immobile, unless you have an underlying condition predisposing you to blood clot formation. Some of these underlying conditions, such as anticardiolipin antibody syndrome, are associated with neurological symptoms. Lastly, you were told you experienced optic neuritis. Depending on your symptoms, exam findings and degree of recovery I would be more concerned about a diagnosis of Anterior ischemic optic neuropathy (AION) or a neuromyelitis optics spectrum disorder in a gentleman of your age.

Please make sure your neurologist has considered these issues and obtained spinal fluid for examination that showed findings consistent with MS before proceeding further with treatment
Good luck

Rip Kinkel MD
Director, University of California San Diego MS Center