abc 10 - tabish60102

[ArchivalUser]

A 32-year-old woman is evaluated in the emergency department for a 2-day history of progressive numbness and weakness in the legs; she has also noted urinary incontinence since awakening this morning. She has no significant medical history and has not had recent infections or vaccinations.

Physical examination shows normal mental status and cranial nerves. Strength is normal in the arms. Both legs are very weak diffusely (2/5). Sensation to pinprick is diminished from the umbilicus down, and vibratory sensation is diminished in the toes. Reflexes are 2+ in the biceps and triceps, 3+ in the knees and ankles, with a bilateral extensor plantar response. Sagittal MRI of the spinal cord shows an enhancing lesion within the spinal cord, with edema, extending from the T8 to the T10 level.

Which of the following is the most appropriate initial management of this patient?

A Intramuscular interferon-beta
B Intravenous acyclovir
] C Intravenous methylprednisolone
D Neurosurgical decompression
E Oral prednisone

[ArchivalUser]

is it A

[ArchivalUser]

cc

[ArchivalUser]

WHAT R U THINKING OF?
Sagittal MRI of the spinal cord shows an enhancing lesion within the spinal cord, with edema, extending from the T8 to the T10 level.

[ArchivalUser]

acute spinal cord compression,first i/v steroid ,then surgical decpmression

[ArchivalUser]

U R RT

[ArchivalUser]

(Correct Answer = C)
Key Points

* Transverse myelitis is an acute or subacute demyelinative or inflammatory disorder of the spinal cord that causes motor, sensory, and autonomic dysfunction below a spinal cord level.
* High-dose intravenous corticosteroids are indicated for initial treatment of acute transverse myelitis.

This patient presents with a subacute onset of bilateral sensory and motor dysfunction in the legs and urinary incontinence; her examination shows sensory loss below the T10 level as well as upper motor neuron signs in the legs. These signs and symptoms suggest a lesion of the spinal cord and are consistent with the lesion seen within her thoracic cord on MRI. The clinical presentation of an acutely, or subacutely, evolving process involving the spinal cord causing severe motor, sensory, and autonomic dysfunction below that level is called a transverse myelopathy. The lesion on MRI most likely represents an acute inflammatory or demyelinative process involving the cord (transverse myelitis), for which the most appropriate treatment is high-dose corticosteroids, usually given in the form of intravenous methylprednisolone for 3 to 5 days. This therapy can be followed by a tapering course of oral prednisone.

This lesion is unlikely to represent tumor, given the patient's rapidly evolving symptoms. In addition, surgical decompression is not appropriate because the lesion is within the spinal cord. Although transverse myelitis can occur in the setting of infectious, postinfectious, or postvaccination processes, specific causative agents are often not apparent; in this case, there is no evidence to support the use of an antiviral agent, such as acyclovir. Although this patient's syndrome might potentially represent the first attack of multiple sclerosis, there is not enough evidence for multiple sclerosis in this patient to support the use of a chronic immunomodulating agent, such as interferon-beta. Even if such evidence was given in this case, the acute treatment would still be high-dose corticosteroids.
Bibliography

[ArchivalUser]

thanks