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Relapsing-Remitting Multiple Sclerosis — SCE Neurology MCQ

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EasyMultiple Sclerosis & CNS InflammationRelapsing-Remitting Multiple SclerosisSCE Neurology

A 32-year-old woman presents with progressive right leg weakness over 2 weeks. Three months ago she had an episode of left optic neuritis that resolved with corticosteroids. MRI brain shows periventricular lesions perpendicular to the ventricles and juxtacortical lesions. MRI spine shows a short-segment thoracic cord lesion. CSF shows oligoclonal bands present in CSF but not serum. What is the most likely diagnosis?

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Correct answer: C — Multiple sclerosis – relapsing-remitting

This presentation fulfils the 2017 McDonald criteria for relapsing-remitting MS: dissemination in space (periventricular, juxtacortical lesions and spinal cord) and dissemination in time (optic neuritis 3 months ago, now a new episode). CSF-specific oligoclonal bands support the diagnosis. A: NMOSD typically has longitudinally extensive cord lesions (≥3 segments) and bilateral optic neuritis; OCBs are typically absent. C: ADEM is usually monophasic. D: MOGAD typically has bilateral optic neuritis, OCBs are usually absent, and lesions are different in distribution. E: Neurosarcoidosis typically involves the meninges and cranial nerves.

Reference: NICE NG100 MS (2022); McDonald Criteria (2017)