Multiple Sclerosis

A 29-year-old non-smoker non-hypertensive female is referred for a second opinion because eight weeks before she had an episode of blurred vision on the left eye and numbness and tingling of the both legs. The blurred vision lasted ten days and cleared completely. The numbness was associated with poor balance and lasted four weeks. There is no past medical history. The ophthalmologist who saw her during her episode found decreased vision on the left eye no papilledema but prescribed oral steroids. The neurological examination eight weeks after the episode was normal.

1. The most likely diagnosis on this patient is

A. Retinal artery occlusion

B. CNS lupus erythematosus

C CNS vasculitis

D. Multiple sclerosis

E. Conversive reaction

ANSWER D

2. The next test to order include all of the following except:

A. Cerebral angiograms

B. Visual evoked responses

C. Sedimentation rate

D. MRI of the brain

E. Lumbar puncture

ANSWER A

3. The MRI of the brain in this patient most likely showed:

A. Multiple cortical infarcts produced by vasculitis

B. A solitary lesion on the right occipital cortex

C. Multiple areas of demyelination in the periventricular areas of the brain.

D. An optic nerve glioma

E. Normal brain

ANSWER C

4. The pathology of the lesion include

A. Granulomatous vasculitis and multiple infarcts

B. Lupus vasculopathy with infarcts

C. Multiple areas of demyelination

D. A glioma of the left optic nerve

E. Normal brain

ANSWER C