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Acute MS relapse — SCE Neurology MCQ

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HardMSAcute MS relapseSCE Neurology

A patient with established relapsing multiple sclerosis develops disabling diplopia and ataxia over three days. Examination shows internuclear ophthalmoplegia and limb dysmetria; infection screening is negative and MRI shows a new enhancing pontine lesion. What is the appropriate treatment?

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Correct answer: B — A short course of high-dose methylprednisolone

The best answer is “A short course of high-dose methylprednisolone”. This is a functionally important inflammatory relapse with a new concordant lesion and no pseudo-relapse trigger; high-dose oral or intravenous methylprednisolone can shorten recovery, though it does not alter the long-term degree of recovery. “Long-term low-dose prednisolone as maintenance treatment” is less appropriate because chronic corticosteroids create substantial toxicity and are not routine MS maintenance “Empirical antibiotics for a possible occult infection trigger” is less appropriate because antibiotics are not indicated without an infectious trigger “Therapeutic heparin for an enhancing inflammatory pontine lesion” is less appropriate because anticoagulation does not treat inflammatory demyelination “Deferred relapse treatment until deficits become persistent” is less appropriate because early relapse assessment supports timely symptom recovery and safety planning

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