USMLE Forum Archives - USMLE Step 3 - Neuro Q
Neuro Q
Sarahhh - 12-28-07 00:54
A 32-year-old woman presents to your outpatient clinic with a several week history of weakness in her left arm, and a more acute visual disturbance. She states that her history actually dates back to approximately 6 months ago. She had a numbness in her right leg that lasted for approximately 3 weeks, but then it resolved spontaneously. Then approximately 3 weeks ago she began to have weakness in her left arm when trying to perform some household tasks. Two days ago she developed acute monocular visual loss in the right eye with periocular pain. She has no significant past medical history. Her temperature is 37.2 C (99 F), blood pressure is 120/80 mm Hg, pulse is 78/min, and respirations are 14/min. On ophthalmologic examination, she has an afferent pupillary defect in the right eye and her visual acuity is 20/20 on the left, and 20/200 on the right. Her extraocular movements are normal, but cause pain in the right eye. She has 3/5 grip strength in her left hand and the remainder of her motor and sensory examination is normal. An MRI of her brain and spine shows multiple hyperintense lesions on T2-weighted images in the white matter tracts as well as her right optic nerve. This patient will likely benefit from therapy with
A. intravenous acyclovir
B. intravenous ceftriaxone after performing a lumbar puncture
C. intravenous methylprednisolone
D. no therapy will be beneficial to this patient
E. radiation therapy to treat the multiple lesions seen on the magnetic resonance scan
Sarahhh - 12-28-07 00:54
A 32-year-old woman presents to your outpatient clinic with a several week history of weakness in her left arm, and a more acute visual disturbance. She states that her history actually dates back to approximately 6 months ago. She had a numbness in her right leg that lasted for approximately 3 weeks, but then it resolved spontaneously. Then approximately 3 weeks ago she began to have weakness in her left arm when trying to perform some household tasks. Two days ago she developed acute monocular visual loss in the right eye with periocular pain. She has no significant past medical history. Her temperature is 37.2 C (99 F), blood pressure is 120/80 mm Hg, pulse is 78/min, and respirations are 14/min. On ophthalmologic examination, she has an afferent pupillary defect in the right eye and her visual acuity is 20/20 on the left, and 20/200 on the right. Her extraocular movements are normal, but cause pain in the right eye. She has 3/5 grip strength in her left hand and the remainder of her motor and sensory examination is normal. An MRI of her brain and spine shows multiple hyperintense lesions on T2-weighted images in the white matter tracts as well as her right optic nerve. This patient will likely benefit from therapy with
A. intravenous acyclovir
B. intravenous ceftriaxone after performing a lumbar puncture
C. intravenous methylprednisolone
D. no therapy will be beneficial to this patient
E. radiation therapy to treat the multiple lesions seen on the magnetic resonance scan
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#1
Re: Neuro Q InSitu - 12-28-07 02:07 Hello Sarah...i will leave this open for discussion. Please try to add a specific title to your cases.
#3
Re: Neuro Q TheOne - 12-28-07 17:07 That's a classical case of MS. An initial treatment with a potent steroid (methylprednisolone) overlaped by Beta-Interferon is recommended.
#4
Re: Neuro Q
Sarahhh - 12-29-07 19:36 the correct answer is C.
This patient is presenting with a fairly classic history for multiple sclerosis (MS), which is characterized by multiple neurologic symptoms separated in space and time. That is to say, a single central nervous system lesion could not explain the signs and symptoms that she has manifested over the past several months. Her ocular symptoms are very characteristic of optic neuritis, which is one of the most common manifestations of MS. Furthermore, she has the classic MRI findings of multiple sclerosis showing multiple plaques on white matter tracts. One of the mainstays of treatment in MS is corticosteroid therapy, and it is particularly useful in the acute setting with optic neuritis.
Intravenous acyclovir therapy (choice A) is often used in herpetic encephalitis that classically affects the temporal lobes of the brain in younger patients and often presents with seizures.
Intravenous ceftriaxone (choice B) is good initial therapy for acute community acquired bacterial meningitis. This clinical presentation is not consistent with meningitis.
No therapy (choice D) is clearly not appropriate for the reasons discussed previously.
Radiation therapy (choice E) is not used in the treatment of MS, and moreover, this clinical scenario is not consistent with any form of malignancy.
#5
Re: Neuro Q babbu5508 - 02-22-11 03:00 This patient will likely benefit from therapy with C. intravenous methylprednisolone..the main treatment for multiple sclerosis...
#9
Re: Neuro Q babbu5508 - 03-31-11 11:55 here is no known cure for multiple sclerosis at this time. However, there are therapies that may slow the disease. The goal of treatment is to control symptoms and help you maintain a normal quality of life.
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