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LA Thrombus Without AF — SCE Neurology MCQ

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HardCerebrovascular DiseaseLA Thrombus Without AFSCE Neurology

A 39-year-old with relapsing multiple sclerosis receives natalizumab. After 30 months of treatment she develops subacute cognitive slowing, left visual-field neglect and progressive hemiparesis. MRI shows a new non-enhancing subcortical white-matter lesion without mass effect. What is the most appropriate immediate management?

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Correct answer: E — Withhold natalizumab and arrange urgent specialist assessment for progressive multifocal leukoencephalopathy

Subacute focal neurological decline with a new white-matter lesion in a natalizumab-treated patient must prompt urgent assessment for PML and interruption of natalizumab while that diagnosis is investigated. Treating presumed relapse without considering PML risks harmful delay.

Reference: MHRA Drug Safety Update, natalizumab (Tysabri): progressive multifocal leukoencephalopathy—updated advice to support early detection: https://www.gov.uk/drug-safety-update/natalizumab-tysabri-progressive-multifocal-leukoencephalopathy-updated-advice-to-support-early-detection