Please take a moment prior to the presentation to answer the following 3 case-based questions.
For each question, please select the best option then click the button at the end of the test to proceed.
A 31-year-old woman presents with a first episode of unilateral optic neuritis. Brain MRI demonstrates 2 periventricular lesions and 1 juxtacortical lesion without gadolinium enhancement. Cervical spine MRI shows a short-segment dorsal column lesion. CSF demonstrates CSF-restricted oligoclonal bands. Serum AQP4-IgG and MOG-IgG are negative. Neurologic examination is otherwise normal.
A 26-year-old man with newly diagnosed relapsing MS has experienced 2 disabling relapses within 1 year with incomplete recovery. MRI demonstrates multifocal gadolinium-enhancing lesions and cervical spinal cord involvement. He is JCV antibody positive with a high index value. He hopes to start a family within 2 years and expresses concern regarding long-term immunosuppression and frequent infusion-center visits.
A 49-year-old woman with relapsing MS treated with fumarate therapy for 5 years reports gradually worsening gait endurance and cognitive slowing over 18 months. She has had no clinical relapses. Conventional MRI demonstrates no new T2 or gadolinium-enhancing lesions. EDSS has increased from 2.5 to 4.0. Additional evaluation demonstrates persistent elevation of serum neurofilament light chain, thalamic atrophy, multiple paramagnetic rim lesions, and progressive retinal nerve fiber layer thinning on OCT.
