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MS Bladder – High PVR and ISC — SCE Neurology MCQ

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HardMultiple Sclerosis & CNS InflammationMS Bladder – High PVR and ISCSCE Neurology

A 66-year-old man has an 18-month ascending, exertion-sensitive paraparesis with sphincter dysfunction. MRI shows longitudinal conus-predominant T2 signal and serpiginous dorsal flow voids. CSF protein is mildly raised and oligoclonal bands are present. What is the decisive next investigation?

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Correct answer: C — Catheter spinal angiography to localise a dural arteriovenous fistula

Explanation lettering: D = shown as C · C = shown as D

A risks anchoring on nonspecific CSF abnormalities; oligoclonal bands do not exclude a structural vascular myelopathy, and steroids may worsen venous congestion. B does not address the highly characteristic cord vascular pattern. C samples the wrong tissue and cannot establish a spinal shunt. D is correct: the progressive conus-predominant myelopathy, exertional fluctuation and perimedullary flow voids strongly suggest a spinal dural arteriovenous fistula; catheter spinal angiography remains the gold standard and localises the lesion for endovascular or surgical treatment. E is unrelated.

Reference: A practical approach to the diagnosis of spinal cord lesions: https://pn.bmj.com/content/18/3/187