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The Plaque, Again!

Topic: Adult

Created on Thursday, November 13 2008 by rednucleus

Last modified on Thursday, November 13 2008.

A 27-year-old woman is referred to you as a newly diagnosed case of relapsing-remitting multiple sclerosis. However, after a thorough examination, you disagree with the referring physician. What have you found?

A) Bilateral Marcus-Gunn pupils

B) Loss of joint position and vibration sensations in the left arm only

C) Scanning speech

D) Bilateral loss of ankle jerks

E) Bilateral bi-directional horizontal gaze-evoked nystagmus

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This question was created on November 13, 2008 by rednucleus.
This question was last modified on November 13, 2008.

ANSWERS AND EXPLANATIONS

A) Bilateral Marcus-Gunn pupils

This answer is incorrect.

From bilateral optic neuritis. (See References)


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B) Loss of joint position and vibration sensations in the left arm only

This answer is incorrect.

Dorsal column signs loss in one limb is highly suggestive of multiple sclerosis in the appropriate clinical setting. (See References)


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C) Scanning speech

This answer is incorrect.

A cerebellar type of dysarthria. (See References)


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D) Bilateral loss of ankle jerks

This answer is correct.

Lower motor neuron signs are highly unusual in multiple sclerosis and their presence should cast a strong doubt upon the diagnosis. However, radicular signs have been described in "advanced" multiple sclerosis due to plaque involvement of the entry/exit paths of the roots. (See References)


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E) Bilateral bi-directional horizontal gaze-evoked nystagmus

This answer is incorrect.

This is highly characteristic of a brainstem/cerebellar (i.e. central) type of nystagmus. (See References)


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References:

1. Victor, M., and Ropper, A.H. (2005). Adams and Victor's Principles of Neurology, 8th Edition. McGraw-Hill, New York. (ISBN:007141620X)

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adult
The Plaque, Again!
Question ID: 111308116
Question written by rednucleus. (C) FrontalCortex.com 2006-2009, all rights reserved. Created: 11/13/2008
Modified: 11/13/2008
Estimated Permutations: 120