Review Question - QID 105002

This patient's history of neurologic deficits separated temporally with a return to baseline with painful vision loss (optic neuritis) is suggestive of multiple sclerosis. Lhermette sign (electrical pain with neck flexion) is also seen in this condition.

Multiple sclerosis (MS) is an inflammatory and neurodegenerative disease of the central nervous system resulting in episodic neurologic dysfunction that often recovers. MS affects twice as many women as men. The classic presentation of MS is typically a young woman with relapsing and remitting neurologic symptoms including weakness, paresthesias, pain, and urinary/bowel symptoms. Unique findings in MS include optic neuritis (painful vision loss), internuclear opthalmoplegia (inability to adduct the eye when examining the cranial nerves), and Lhermette sign (electrical pain that shoots down the neck with neck flexion).

Incorrect Answers:
Answer 2: Ipsilateral loss of proprioception and vibration sensation and contralateral loss of pain/temperature sensation is suggestive of a Brown-Sequard hemisection which is a traumatic transection of the spinal cord.

Answer 3: Pruritus with exposure to heat describes aquagenic pruritus which is common in polycythemia vera which presents with an increase in all 3 cell lines (red blood cells, white blood cells, and platelets).

Answer 4: Symmetric lower extremity reflex loss and ascending paralysis describes Guillain-Barre syndrome which occurs after a diarrheal illness and can involve the diaphragm leading to respiratory failure. The neurologic symptoms of MS tend to be relapsing and remitting and typically do not start progressively in the lower extremities and spread superiorly.

Answer 5: Weakness with repeat exertion describes myasthenia gravis which presents with weakness/diplopia at the end of the day secondary to post-synaptic anticholinergic antibodies.

Bullet Summary:
Lhermette sign can be seen in multiple sclerosis.