Neurology: Case of the Month

Test Yourself — Patient 39

Motoneuron Disease with Coexistent Demyelinating Disease

1. Clinical features atypical for a diagnosis of amyotrophic lateral sclerosis include:
   • [ A ] Visual abnormality attributable to an anterior visual pathway lesion.
   • [ B ] Depressed or absent tendon reflexes in any muscle group.
   • [ C ] Sphincter abnormalities
   • [ D ] Preservation of extraocular muscle function
   • [ E ] A and C
   • [ F ] A, B, and C
2. Focal muscle atrophy in patients with an established diagnosis of multiple sclerosis may occur as a result of:
   • [ A ] Comorbid disease affecting the lower motoneuron.
   • [ B ] Disuse
   • [ C ] Demyelinating lesions in the ventral root exit zone, with secondary axonal injury
   • [ D ] A and C
   • [ E ] A, B, and C
3. Increased CSF immunoglobulin synthesis and/or oligoclonal banding on CSF electrophoresis are virtually always indicative of a diagnosis of multiple sclerosis.
   • [ A ] True
   • [ B ] False
4. Motoneuron disease is generally untreatable, unless a treatable comorbid condition can be identified.
   • [ A ] True
   • [ B ] False
5. Motoneuron disease and CNS demyelinating lesions may coexist as a result of:
   • [ A ] Systemic immune-inflammatory disease
   • [ B ] Viral infection
   • [ C ] Chance association of independently occurring disorders
   • [ D ] A and C
   • [ E ] A, B, and C

 

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