Young woman presenting with neurological symptoms separated in time and space, including Lโhermitteโs sign (electric-like sensation with neck flexion) and optic neuritis (unilateral painful vision changes/loss) with a brain MRI showing multifocal, ovoid subcortical white matter lesions in a periventricular distribution most consistent with multiple sclerosis
Key idea: Multiple sclerosis is treated chronically with immunosuppressants, but an acute MS flare (such as this patient) should be treated with glucocorticoids, interferon beta or plasmapheresis
spiroskeetThis patient is currently asymptomatic, which is why treatment for her should be IFN-ฮฒ (or glatiramer or natalizumab).
If she still had symptoms of an acute MS exacerbation, treatment would consist of corticosteroids (i.e., dexamethasone/methylprednisolone). If symptoms persist in spite of steroids, she should undergo plasmapheresis.+22
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