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MS – Subclinical MRI/NEDA — SCE Neurology MCQ

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HardMultiple Sclerosis & CNS InflammationMS – Subclinical MRI/NEDASCE Neurology

A woman with MS develops subacute leg weakness over 4 days. Temperature is 38.2°C and urinalysis suggests infection; MRI shows no new lesion. What should precede labelling and treating an MS relapse?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Treat infection, then reassess whether neurological weakness persists

Explanation lettering: C = shown as A · D = shown as B · E = shown as C · B = shown as D · A = shown as E

A is correct. NICE defines relapse as new or worsening symptoms lasting over 24 hours after stability and in the absence of infection or another cause. Urinary infection can cause pseudo-relapse and steroid may worsen it, so infection is treated and neurological status reassessed. Duration alone does not prove relapse or progression, and plasma exchange is not first-line for this unresolved presentation.

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