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MS bladder dysfunction — SCE Neurology MCQ

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ModerateMSMS bladder dysfunctionSCE Neurology

A 27-year-old woman presented with urgency, frequency and urge incontinence in longstanding MS. On examination, there was spastic paraparesis and sensory level to T8. Initial investigations showed: post-void residual was low and urine culture was negative. What is the most appropriate management?

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Correct answer: D — High-dose methylprednisolone for disabling relapse after excluding infection

High-dose methylprednisolone for disabling relapse after excluding infection is the best answer because the vignette describes MS bladder dysfunction: detrusor overactivity is common in suprasacral MS cord disease. Multidisciplinary rehabilitation with goal-setting is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. High-dose intravenous methylprednisolone after excluding infection and Intravenous immunoglobulin with respiratory monitoring are less appropriate because they would require different localisation, timing or test findings; Optimise dopaminergic therapy and review motor fluctuations would fit a different syndrome. Clinical pearl: overflow retention would give high residual volume.

Reference: NICE NG220; ABN guidance on disease-modifying therapies for MS