Multiple Sclerosis — Clinical

A 32-year-old woman from Delhi presents with acute onset diplopia and right eye pain on eye movement for 3 days. She reports a similar episode of left leg weakness 2 years ago that resolved spontaneously over 6 weeks. On examination, she has impaired adduction of the right eye with intact pupillary responses. MRI brain shows a T2-hyperintense lesion in the right medial longitudinal fasciculus (MLF). Lumbar puncture reveals oligoclonal bands in CSF. What is the most likely diagnosis?

A 28-year-old woman from Mumbai with known relapsing-remitting multiple sclerosis (RRMS) on interferon-beta therapy presents with acute onset of severe headache, fever (38.5°C), and neck stiffness for 2 days. She has no recent travel or sick contacts. CSF analysis shows lymphocytic pleocytosis (85 cells/μL, 90% lymphocytes), protein 65 mg/dL, glucose 48 mg/dL (serum glucose 95 mg/dL), and negative bacterial culture. Brain MRI shows no acute lesions. What is the most appropriate next step in management?

A 28-year-old woman from Delhi presents with acute onset diplopia and right eye pain on eye movements for 3 days. On examination, she has right afferent pupillary defect and impaired colour vision. MRI brain shows T2-hyperintense lesion in the right optic nerve. CSF analysis reveals oligoclonal bands and elevated IgG index. What is the most appropriate next step in management?

A 35-year-old woman with a 6-year history of relapsing–remitting multiple sclerosis (RRMS) presents with progressive weakness in both legs and cognitive slowing over the past 18 months, despite being on interferon-beta. MRI shows multiple T2 lesions in the spinal cord and brain. CSF shows elevated IgG index. What is the most likely diagnosis and the recommended next step in management?

Which of the following is the most common initial presentation of multiple sclerosis in adults?