07-19-2009, 08:28 PM
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
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