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Failed Vision!

Topic: Adult

Created on Saturday, November 8 2008 by rednucleus

Last modified on Saturday, November 8 2008.

A 27-year-old woman presents with progressive visual failure on the right side over a matter of 4 days. She was reasonably well and healthy and did not do drugs. Her bloods and urine are unremarkable. Examination reveals right-sided visual acuity of finger counting, Marcus-Gunn pupil, and a normal-looking fundus. Her planters are up and she has left arm akinesthesia. Which one of the following would cast a doubt on the diagnosis of multiple sclerosis?

A) Partial Brown- Sequard syndrome at C5

B) Urinary frequency

C) Simple partial motor seizures

D) Euphoria

E) Rubral-type tremor

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This question was created on November 08, 2008 by rednucleus.
This question was last modified on November 08, 2008.

ANSWERS AND EXPLANATIONS

A) Partial Brown- Sequard syndrome at C5

This answer is incorrect.

Note that the presence of uni- or bilateral “partial” Brown-Sequard syndrome should always prompt the neurologist search for multiple sclerosis. (See References)


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B) Urinary frequency

This answer is incorrect.

Urinary retention is seen in the acute phase of transverse myelitis. Gradually, this is replaced by urinary frequency and urge incontinence (small spastic bladder). (See References)


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C) Simple partial motor seizures

This answer is correct.

Seizures may occur “late” in the course of multiple sclerosis due to irritation by juxta-cortical plaque(s), but this is actually rare in clinical practice; their presence at the time of diagnosis should strongly question the presence of multiple sclerosis. (See References)


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D) Euphoria

This answer is incorrect.

Depression, euphoria, personality changes, and lately, sub-cortical type of dementia can be seen in multiple sclerosis. Depression may be due to multiple sclerosis per se, as a negative reaction to its diagnosis, or as a complication of interferon beta therapy. (See References)


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E) Rubral-type tremor

This answer is incorrect.

Rubral-type tremor is an aggressive form of tremor that interferes with every day activities, like eating, toileting, bathing...etc. Its treatment is unfortunately unsatisfactory; wrist weights may help. Note that she has left arm akinesthesia; dorsal column signs in “one” limb is very suggestive of multiple sclerosis. (See References)


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References:

1. Victor, M., and Ropper, A.H. (2001). Adams and Victor's Principles of Neurology, 7th Edition. McGraw-Hill, New York. (ISBN:0070674973)

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adult
Failed Vision!
Question ID: 110808051
Question written by rednucleus. (C) FrontalCortex.com 2006-2009, all rights reserved. Created: 11/08/2008
Modified: 11/08/2008
Estimated Permutations: 120