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BPPV – Dix-Hallpike and Epley — SCE Neurology MCQ

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HardHeadache & Facial PainBPPV – Dix-Hallpike and EpleySCE Neurology

A patient with multiple sclerosis has a painful sustained inward turning of one foot lasting minutes, triggered by walking. Examination between episodes shows pyramidal signs. Which symptom description is most useful for targeted treatment?

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Correct answer: C — Painful tonic spasm or focal dystonic spasm related to central demyelination

The best answer is “Painful tonic spasm or focal dystonic spasm related to central demyelination”. Brief stereotyped painful posturing in MS is a paroxysmal tonic spasm; distinguishing it from spasticity and peripheral cramp guides treatment. “A length-dependent sensory neuropathy” can be reasonable in another presentation, but it does not account for the defining feature here. “Restless legs syndrome” can be reasonable in another presentation, but it does not account for the defining feature here. “Orthostatic tremor” can be reasonable in another presentation, but it does not account for the defining feature here. “Functional gait disorder diagnosed from pain alone” can be reasonable in another presentation, but it does not account for the defining feature here.

Reference: NICE NG220 multiple sclerosis recommendations: https://www.nice.org.uk/guidance/ng220/chapter/Recommendations