Review Question - QID 107055

This patient's clinical presentation is consistent with a multiple sclerosis (MS) flare, which should be treated with high-dose IV solumedrol and hospital admission.

Multiple sclerosis (MS) is a demyelinating disease with likely autoimmune pathophysiology. Patients often present with a history of multiple episodes of self-resolving neurological symptoms, such as limb weakness or optic neuritis. Symptom prophylaxis typically includes beta-interferons and immunosuppressants, while high-dose, IV steroids are the cornerstone of treatment for acute flares. The overall prognosis ranges from prolonged remission to rapid death.

Nicholas and Rashid review MS. They note that early MS is relapsing-remitting in 90% of patients. However, most patients experience a primary progressive course within 6-10 years of onset. Many patients live with MS for 30 or more years, and the overall life expectancy in patients with MS is not significantly reduced.

Alvermann et al. perform a review of cerebrospinal fluid (CSF) findings in MS. They note that, while nearly every study notes CSF pleiocytosis, specific immunotyping may offer further specificity for diagnosing MS and its prognosis. Of note, some studies have shown increased T-helper cells and T-regulatory cells in CSF in patients with MS.

Figure A shows Dawson's fingers: white, finger-like protrusions perpendicular from the ventricles. Illustration A shows the patterns of progression in MS. Illustration B shows optic neuritis, which typically presents without abnormalities on fundal exam but may show a swollen optic disc, as is seen in this photo.

Incorrect Answers:
Answer 1: Interferon beta is used for symptom prophylaxis, not for acute flares.
Answer 3: Steroids should be given intravenously, not orally, for MS flare-ups.
Answer 4: Riluzole is used to slow progression of amyotrophic lateral sclerosis (ALS). Its mechanism of action is to decrease presynaptic glutamate release.
Answer 5: EMGs are performed to diagnose muscle disorders, such as muscular dystrophy or polymyositis, nerve disorders such as myasthenia gravis, carpal tunnel syndrome, and ALS among others.