neuro q 2 - math3

[ArchivalUser]

a 26 yr old pt presents with weakness of right upper arm extremity ,left lower extremity and ataxia ,she also complains of unilateral loss of vision.what is the next step?
CT with contrast
MRI
PET scan
lumbar puncture

[ArchivalUser]

mri
sclerosis multlple

[ArchivalUser]

multiple sclerosis, MRI? or CSF? I think CSF first?

[ArchivalUser]

csf for MS will show normal protein,cell count etc

[ArchivalUser]

mri first and when only when mri is non confirmatory do CSF for oligoclonal bands

[ArchivalUser]

CT with contrast or MRI with contrast is good for finding tumors. CT without contrast is good for intracranial bleeds (Acute) and skull fractures.
MRI is great for demyelinating disorers. It is also good for tumors - and pituitary stuff and posterior cranial fossa stuff.
PET is good for Identifying occult cancer - so if CT/MRI do not give an answer and clinical suspicion is still high, use PET.
Lumbar puncture is used for the following - NPH, Pseudotumor, Suspected SAH with negative CT, MS not diagnosed by MRI (look for monoclonal band - Poser's criteria) Remember MS is rare over 55 years age.
OF COURSE LP is used for meningitis, CSF PCR for herpes encephalitis, memingeal mets & Monitoring neurosyphilis. Other conditions for LP are not too important

[ArchivalUser]

to me it does not look an MS, or u did a summary of the stem of the question,,, there should be transient neurological finding,,, here i don't see anything, as the q says it is like an acute thing like a stroke of something,,,but every thing said about lab here is correct if you assume this case a MS,,, the only indication can be the age and the sex of the pt nothing else...
please correct me if i am wrong...

[ArchivalUser]

and yes unilateral loss of vision is piece of information that can work on it but again...can't say for sure...