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MS Specialist Nurse – NICE Role — SCE Neurology MCQ

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HardMultiple Sclerosis & CNS InflammationMS Specialist Nurse – NICE RoleSCE Neurology

A 38-year-old woman with relapsing-remitting multiple sclerosis reports 36 hours of new right-leg weakness that now impairs walking. Examination confirms a new pyramidal deficit. She is afebrile but has dysuria, pyuria and a raised C-reactive protein; urine culture is pending. Which plan best follows the UK relapse pathway?

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Correct answer: C — Treat the urinary infection and reassess the deficit as inflammation settles

A relapse is diagnosed only after infection and other causes of neurological deterioration have been excluded. Urinary symptoms, pyuria and inflammation make infection-associated worsening a material possibility even without fever. The infection should therefore be treated and the deficit reassessed promptly; persistent function-limiting neurology can then be considered for relapse treatment. MRI enhancement is not required to diagnose a clinical relapse, and neither the 24-hour duration criterion nor impaired walking removes the need to exclude infection. Disease-modifying treatment decisions depend on the subsequent relapse assessment rather than this single unconfirmed episode.

Reference: NICE NG220, Multiple sclerosis in adults — recommendations: https://www.nice.org.uk/guidance/ng220/chapter/recommendations