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Neuroimmunology

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Which of the following statements is true of relapsing–remitting multiple sclerosis (MS)?

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(A) The female predominance is approximately 4 to 1.

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(B) Slowly evolving upper motor neuron syndrome of the legs is typical of the relapsing–remitting form of MS.

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(C) An increase in body temperature may exacerbate symptoms.

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(D) The presence of oligoclonal bands reduces the risk of recurrence.

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(E) Women with predominantly sensory symptoms have a more serious prognosis.

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(C) In relapsing–remitting MS, the type of MS present in 80% of patients, symptoms and signs typically progress over a period of several days, stabilize, and then often improve spontaneously or in response to corticosteroids within weeks. Relapsing–remitting MS typically begins in the second or third decade of life and has a female predominance of approximately 2 to 1. The tendency for corticosteroids to speed recovery from relapses often diminishes with time. Persistent signs of CNS dysfunction may develop after a relapse, and the disease may progress between relapses. Twenty percent of affected patients have primary progressive MS, which is characterized by a gradually progressive clinical course and a similar incidence among men and women. Relapsing–remitting MS typically starts with sensory disturbances, unilateral optic neuritis, diplopia (internuclear ophthalmoplegia), Lhermitte's sign, limb weakness, clumsiness, gait ataxia, and neurogenic bladder and bowel symptoms. Many patients describe fatigue that worsens in the afternoon and is accompanied by physiological increases in body temperature. Prominent cortical signs (aphasia, apraxia, recurrent seizures, visual-field loss, and early dementia) and extrapyramidal phenomena only (chorea and rigidity) rarely dominate the clinical picture.

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Patients who have primary progressive MS often present with a slowly evolving upper motor neuron syndrome of the legs. Typically, this variant worsens gradually, and quadriparesis, cognitive decline, visual loss, brain stem and cerebellar syndromes, bowel, bladder, and sexual dysfunction may develop. The diagnosis is based on established clinical and, when necessary, laboratory criteria. Advances in CSF analysis and MRI, in particular, have simplified the diagnostic process. The relapsing forms are considered clinically definite when neurological dysfunction becomes disseminated in space and time. Studies of the natural history of the disease have provided important prognostic information. Ten percent of patients do well for more than 20 years and are thus considered to have benign MS. Approximately 70% will have secondary progression. Frequent relapses in the first 2 years, progressive course from the onset, male sex, early permanent motor or cerebellar findings, and presence of oligoclonal bands in the CSF are associated with the more severe course of the disease. Women and patients with predominantly sensory symptoms and optic neuritis have a more favorable prognosis. (Noseworthy, 938–952)

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Which of the following statements is ...

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