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SSEPs in MS – Dorsal Column Assessment — SCE Neurology MCQ

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HardClinical NeurophysiologySSEPs in MS – Dorsal Column AssessmentSCE Neurology

A 45-year-old man undergoes somatosensory evoked potentials (SSEPs) as part of his MS investigation. Stimulation of the posterior tibial nerve at the ankle shows a delayed cortical P37 response. What does this indicate?

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Correct answer: D — Demyelination in the dorsal column-medial lemniscal pathway between the ankle and the somatosensory cortex

The best answer is “Demyelination in the dorsal column-medial lemniscal pathway between the ankle and the somatosensory cortex”. UK stroke guidance supports urgent vascular imaging and reperfusion selection, short-course dual antiplatelet therapy for eligible minor stroke or high-risk TIA, decompression for life-threatening swelling, and secondary prevention matched to mechanism. The alternatives “Normal finding, after excluding important mimics, after specialist assessment, when the phenotype supports it”, “Motor pathway dysfunction, after specialist assessment, when the phenotype supports it, within the relevant UK pathway”, “Peripheral neuropathy, when the phenotype supports it, within the relevant UK pathway”, “Cerebellar pathology, within the relevant UK pathway, after excluding important mimics, after specialist assessment” are clinically adjacent possibilities, but they do not match the defining chronology, localisation, physiology, investigation result or UK management sequence in this stem.

Reference: National Clinical Guideline for Stroke: acute care: https://www.strokeguideline.org/chapter/acute-care/