Which signs and symptoms commonly occur in patients with this disease? A 35-year-old woman comes to the physician with right-handed paralysis, ataxia, and difficulty urinating for the past 36 hours. The patient states that she has had a generalized right-sided weakness for years along with episodes of sensory numbness and/or motor paralysis. The episodes normally last a few days, and the last episode occurred 18 months ago. Her left hand became so weak that she could not write with it. MRI of the brain is significant for periventricular white matter plaques.

Vision loss in one eye, usually lasting a few days

The correct answer is E. This patient most likely has multiple sclerosis, a CNS demyelinating disorder characterized by neurologic lesions that produce signs and symptoms that are separated by both time (i.e., episodes greater than 1 month apart) and anatomic location within the white matter of the CNS. Patients typically also have difficulty in urination or incomplete voiding. By definition, multiple sclerosis (MS) episodes produce symptoms that last longer than 24 hours. The exact etiology is unknown, but there is evidence supporting a role of autoimmune antibodies that attach to CNS myelin-secreting oligodendrocytes. Episodes of optic neuritis (temporary unilateral vision loss) occur in 15%20% of MS patients. Over 90% of patients have multiple periventricular plaques found on MRI of the brain Answer A is incorrect. Chorea, the condition described in this answer, is not particularly associated with MS Answer B is incorrect. Permanent bilateral resting tremors of the upper extremities are not particularly associated with MS. Intention tremors and ataxia (denoting cerebellar disease) are commonly associated with MS Answer C is incorrect. Permanent progressive paralysis of the respiratory muscles is not particularly associated with MS Answer D is incorrect. Raynauds phenomenon, the condition described in this answer, is not particularly associated with MS.