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Clinically isolated syndrome — SCE Neurology MCQ

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HardMSClinically isolated syndromeSCE Neurology

A 63-year-old woman presented with first episode of partial transverse myelitis with a sensory level. On examination, there were brisk reflexes and an extensor plantar response. Initial investigations showed: MRI brain showed several periventricular ovoid lesions; CSF oligoclonal bands were present. Where is the most likely anatomical localisation?

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Correct answer: C — thoracic cord and periventricular white matter

The best answer is “thoracic cord and periventricular white matter”. UK stroke guidance supports urgent vascular imaging and reperfusion selection, short-course dual antiplatelet therapy for eligible minor stroke or high-risk TIA, decompression for life-threatening swelling, and secondary prevention matched to mechanism. The alternatives “Basal ganglia nigrostriatal pathway”, “Ventral pons, after excluding important mimics”, “Dominant temporal lobe, after specialist assessment”, “Cerebellopontine angle, when the phenotype supports it” are clinically adjacent possibilities, but they do not match the defining chronology, localisation, physiology, investigation result or UK management sequence in this stem.

Reference: National Clinical Guideline for Stroke: acute care: https://www.strokeguideline.org/chapter/acute-care/