Review Question - QID 102727

The patient in the vignette most likely has multiple sclerosis (MS), presenting with internuclear ophthalmoplegia (failure to adduct the eye) and optic neuritis (painful vision loss). IV corticosteroids such as methylprednisolone should be used to treat an acute exacerbation of MS.

Multiple sclerosis (MS) is an autoimmune demyelinating disease. Patients often present with a history of multiple episodes of self-resolving neurological symptoms, such as limb weakness, optic neuritis, parethesias, urinary incontinence/retention, or internuclear ophthalmoplegia. The diagnosis can be supported with an MRI of the brain. Medical management focuses on both prophylaxis with beta-interferons and immunosupressants as well as treatment with high-dose IV steroids such as methylprednisolone during acute flares. IV steroids can improve recovery and outcomes such as vision loss.

Incorrect Answers:
Answers 1-4: Estriol, glatiramer acetate, interferon-beta, and rituximab are all indicated in preventing multiple sclerosis flares but would not be optimal management of an acute flare.

Bullet Summary:
IV steroids such as methylprednisolone are indicated in an acute multiple sclerosis flare.