abc2 - tabish60102

[ArchivalUser]

A 28-year-old woman comes to the office because of diplopia on lateral gaze in either direction that has worsened over several days. She has no history of neurologic problems. Neurologic examination is normal except for paresis of the adducting eye with nystagmus of the abducting eye on horizontal gaze in either direction. MRI shows a hyperintense lesion on T2-weighted images within the midbrain, as well as five hyperintense lesions in the cerebral white matter adjacent to the lateral ventricles.

Which of the following long-term treatments should be considered?

A Mitoxantrone
B Cyclophosphamide
C Interferon-beta
D Aspirin
E Clopidogrel

[ArchivalUser]

I am really sure what the dx is? But I will go for E

[ArchivalUser]

Dx?????

[ArchivalUser]

CC,MS?

[ArchivalUser]

C
multiple sclerosis

[ArchivalUser]

orrect Answer = C)
Key Points

* Vertebral artery dissection typically presents with neck or head pain, Horner's syndrome, dysarthria, dysphagia, decreased pain and temperature sensation, dysmetria, ataxia, and vertigo.
* Magnetic resonance angiography is a sensitive diagnostic test for vertebral artery dissection as a cause of stroke.

This patient has an ischemic stroke (cerebral infarction). The symptoms and signs involve multiple lower cranial nerves (dysphagia, dysarthria), crossed sensory deficits, and cerebellar ataxia, which suggest a left lateral medullary localization, possibly also involving the left cerebellum. The sudden onset of symptoms suggests that stroke is the cause. The normal CT rules out a parenchymal intracerebral hemorrhage, which would be unlikely in the medulla. Blood is supplied to this area by the posterior inferior cerebellar artery, a major branch of the vertebral artery. In a previously healthy young person, the less common causes of stroke must be considered, such as vertebral artery dissection, which often occurs spontaneously without trauma or typical vascular risk factors. Typical symptoms of vertebral dissection include neck or posterior head pain, Horner's syndrome (ptosis and miosis), dysarthria, dysphagia, decreased pain and temperature sensation of the face and contralateral body, dysmetria, ataxia, and vertigo. Magnetic resonance angiography is an excellent tool in diagnosing dissection. Noncontrast CT scan in 24 hours will only reveal the evolving stroke, not its cause. Carotid ultrasound studies do not reliably characterize abnormalities in the vertebral artery other than reversal of flow. Lumbar puncture is used to evaluate suspected subarachnoid hemorrhage in a patient who has a severe headache with a normal CT scan, but such localized medullary symptoms would be atypical for subarachnoid hemorrhage.
Bibliography

[ArchivalUser]

SORRY WRONG ONE

[ArchivalUser]

Correct Answer = C)
Key Point
Treatment with interferon-beta decreases the incidence of additional attacks in patients with monosymptomatic demyelination, including optic neuritis and myelopathy.

This patient has bilateral internuclear ophthalmoplegia, a classic presentation of multiple sclerosis. Since there is no history of neurologic problems, this is a clinically isolated or monosymptomatic presentation of demyelination. In this case, MRI shows the causative white-matter lesion in the midbrain, as well as multiple hyperintense lesions adjacent to the lateral ventricle, which are typical of multiple sclerosis. Treatment with interferon-beta decreases the incidence of additional attacks in patients with monosymptomatic demyelination (including optic neuritis and myelopathy) who have multiple œsilent lesions that are typical of demyelination on brain MRI.

Mitoxantrone and cyclophosphamide are sometimes used for severe secondary progressive multiple sclerosis but would not be considered for treatment of a first attack. The patient's presentation does not suggest cerebrovascular disease; therefore, aspirin and clopidogrel are not appropriate.

[ArchivalUser]

thanx again