Extending northeastward from a cluster of lights at Parkersburg (P), a thin but distinct ribbon follows the Ohio River and widens at Wheeling and Weirton. Morgantown (M) is the largest of clusters that follows the west flank of the Chestnut Ridge southwest to northeast from Clarksburg, to the south, far into Pennsylvania near Latrobe. One of the most surprising features, in my mind, is the scattered dim light in the coalfields south of Charleston (C) and west of Beckley (B). I expect this comes from the many small coal camps and surface-mining operations.
Other distinct features that might be discerned in this image include Columbus, (the bright, concentrated node of light northwest of Parkersburg), Pittsburgh, the large cluster of lights north of Morgantown, the D.C.-metro area along the eastern edge of the image, and the thin ribbon of development that follows Interstate 81 across the image from northwest to southeast.
I've included a reference map here to help orient readers who'd like to further explore this image.