Neurology Main神经内科 91-100-课件.ppt

Neurology Main 91-100 Q 91A 26-year-old woman comes to the emergency department with numbness and weakness of both legs. Throughout the prior day, she felt like her legs kept going to sleep and on waking this morning, she had difficulty standing up and walking. She also reports urinary urgency and 2 episodes of involuntary urine leakage. The patient has no history of back pain or trauma. Four years ago, she was diagnosed with type 1 diabetes mellitus; and her glycemic control is maintained by continuous subcutaneous insulin infusion pump. One year ago, she was evaluated for right eye pain and impaired vision, but these resolved spontaneously in a week. Temperature is 36.9 C (98.4 F), blood pressure is 134/78 mm Hg, and pulse is 76/min. Visual acuity and pupillary reflexes are normal. Muscle strength in the right and left lower extremities are 3/5 and 4/5f respectively. Patellar reflexes are 3+ on both sides, and plantar reflexes are upgoing. Sensation to vibration, light touch, and pain is decreased in both legs. Her fingerstick glucose level is 144 mg/dL. Which of the following is the most likely cause of this patients current symptoms?A. Anterior cerebral artery occlusion B. Diabetic polyneuropathy C. Guillain-Barre syndrome D. Multiple sclerosis E. Parasagittal meningioma F. Vitamin B12 deficiency A 91Correct answer:DThis patient likely has multiple sclerosis (MS)r an autoimmune inflammatory demyelinating disorder of the central nervous system (CMS) that typically presents with neurologic deficits disseminated in space and time in women age 15-50. MS should be suspected in patients with 2 distinctive episodes of CNS dysfunction with at least some resolution that cannot be explained by a single lesion. Symptoms occur over hours to days and then improve over weeks to months, although some may be permanent. Common initial symptoms may include:1. Optic neuritis: monocular visual loss, painful eye movements, and afferent pupillary defect2. Transverse myelitis: motor a