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Multiple Sclerosis — RACP Adult Medicine MCQ

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EasyNeurologyMultiple SclerosisRACP Adult Medicine

A 35-year-old woman presents with optic neuritis (painful unilateral visual loss). MRI brain shows multiple periventricular white matter lesions perpendicular to the ventricles with at least one gadolinium-enhancing lesion. CSF shows oligoclonal bands. What is the most likely diagnosis?

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Correct answer: D — Multiple sclerosis

Optic neuritis with periventricular lesions perpendicular to the ventricles (Dawson fingers), gadolinium enhancement (dissemination in time), and CSF oligoclonal bands fulfils the McDonald criteria for multiple sclerosis. The periventricular perpendicular orientation is highly characteristic of MS plaques.

Reference: ABN/MSA – 2024 – MS Diagnosis Guidelines; McDonald 2017 Criteria