has a hx of difficulty in swallowing and weakness in her right upper limb 2y ago. What is the inv
of choice?
a. CSF analysis
b. EEG
c. EMG
d. MRI brain
e. Visual evoked response test
answer: CT scan, diagnosis: MS
Clinical Features
• symptoms include numbness, visual disturbance (optic
neuritis), weakness, spasticity, diplopia
(e.g. INO), impaired gait, vertigo, bladder dysfunction(autonomic dysfunction), cognitive impairment, pain, paraesthesia
• Lhermitte’s sign: flexion of neck causes electric shock
sensation down back into limbs
indicating cervical cord lesion
• Uhthoff’s phenomenon: worsening of symptoms
(classically optic neuritis) in heat
• SPMS: classically weakness of legs in pyramidal
distribution paired with cerebellar findings of
arms (i.e. intention tremor)
• symptoms not commonly found in MS: visual field
defects, aphasia, apraxia, progressive hemiparesis
• relapse: acute/subacute onset of clinical dysfunction
that peaks from days to weeks, followed by
remission with variable symptom resolution (symptoms must
last at least 24 h)
Investigations
• MRI: demyelinating plaques appear as hyperintense
lesions on T2 weighted MRI, with active
lesions showing enhancement with gadolinium
• CSF: oligoclonal bands in 90%, increased IgG
concentration
• evoked potentials (visual/auditory/somatosensory):
delayed but well-preserved wave forms
MRI not CT
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