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How good at neurology are you? — QUESTIONS

1. Read the stem and answer the questions
   
   
   A middle aged woman presents with progressive weakness in the legs, ascending numbness on the trunk, and urinary retention. Within four days she has a paralysed right leg, severe left leg weakness, and loss of position sense in the feet. Pain sensation reduced to T4 right, T11 dermatome on the left, sparing lower sacral dermatomes. Over the previous eight years there have been three episodes of optic neuritis, the most recent two weeks before this presentation—these had reduced acuity to just light perception in the right eye. Her sagittal T2 MRI scan of the cervical and upper thoracic spinal cord is illustrated.
   
   • What is the diagnosis?
     
   • What would her brain MRI show?
     
   • Will the CSF contain oligoclonal bands?
     
   • Which test would aid diagnosis and prognosis?
     
   • What treatment would you provide?
     
   
   Philip C H Baker, New Zealand
   
2. The patient depicted in the figure complained . . . [Full text of this article]