Neurology: Case of the Month

Test Yourself — Patient 8

Multiple Sclerosis (MS)

1. The following statement is TRUE regarding symptoms of MS.
   • [ A ] Frank dementia is a common feature.
   • [ B ] Bilateral optic neuritis is the most common presentation.
   • [ C ] Around 22-45% of patients have sensory symptoms at onset.
   • [ D ] Less than 5% of patients have motor symptoms at onset.
2. The following statement is NOTE TRUE about the prognosis in MS.
   • [ A ] MS appears to follow a more benign course in women.
   • [ B ] Onset at an early age carries a less favorable prognosis.
   • [ C ] The relapsing form of MS favors a better prognosis than the progressive form.
   • [ D ] Patients with impairment of sensory pathways or cranial nerve dysfunction have a more favorable prognosis than those with pyramidal, brainstem, and cerebellar symptoms.
3. The following statement is TRUE regarding the MRI findings in patients with MS.
   • [ A ] The MRI is considered to be less reliable in patients over age 50.
   • [ B ] Only 5% of patients with definite MS will have MRI white matter lesions typical of MS.
   • [ C ] Typical MS lesions usually appear hypodense on proton density and T2 weighted images and hyperintense on T1 weighted images.
   • [ D ] The MRI is not useful as an aid to the diagnosis of MS.
4. Select the BEST statement that describes the CSF findings in MS.
   • [ A ] IgG synthesis is elevated in 70-90% of cases.
   • [ B ] Oligoclonal bands are found in 85-95% of patients.
   • [ C ] IgG/albumin ratio is abnormal in 60-73% of patients.
   • [ D ] All of the above.
5. The following statement is TRUE regarding pathology of MS.
   • [ A ] Active MS plaques have perivascular infiltration of lymphocytes (predominantly T cells).
   • [ B ] Chronic, inactive plaques have poorly defined demarcations, are hypercellular, and exhibit lymphocytic proliferation.
   • [ C ] Plasma cells are not seen in MS plaques.
   • [ D ] MS plaques are discrete regions of demyelination with total axonal loss.

 

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