A 43 year old woman presented with blurred vision and intermittent clumsiness

A 43 year old woman presented with blurred vision and intermittent clumsiness for 3 months. Reflexes are brisk in her arm and optic disc is pale. What is the SINGLE most appropriate test to confirm diagnosis?

A. CSF analysis
B. CT
C. MRI
D. EEG
E. EMG

She has features suggestive of multiple sclerosis. Investigation of choice is an MRI scan.

Multiple Sclerosis

Presentation: Variety of symptoms involving motor and sensory mainly of the brainstem and cerebellum. It may be easier to divide them into groups to remember.

• 1. Transverse myelitis: • Weakness, sensory symptoms • Urinary urgency and retention • Flexor spasms • Spastic quadriparesis or paraparesis

• 2. Brainstem: • Ataxia • Diplopia • Dysarthria • Facial numbness • Ophthalmoplegia • Gaze palsy

• 3. Cerebellum • Ataxia • Dysarthria • Nystagmus

• PLAB 1 stem usually have some clue to optic neuritis. Optic neuritis is an acute, sometimes painful, reduction or loss of vision in one eye and is a relatively common presenting symptom of MS. Colour vision may be impaired • Also depression is common

Pattern is usually: symptoms evolve over days, plateau, then resolves over days/weeks

Diagnosis: • Mostly a clinical diagnosis • MRI (definitive diagnostic test): demyelination and/or lesions disseminated in time and place • Oligoclonal bands in CSF Treatment: • Acute: IV or oral methylprednisolone • Interferon-beta or glatiramer acetate (first line)