A 28-year-old woman is seen in the clinic after a single episode of blurred and double vision, weakness, and clumsiness lasting several days. The patient asks the nurse if she has multiple sclerosis
The nurse will tell this patient that the provider will:
a. await a second clinical attack to confirm the diagnosis.
b. consider her symptoms diagnostic of multiple sclerosis.
c. order a magnetic resonance imaging (MRI) scan now and another when a second clinical attack occurs.
d. have a definitive diagnosis based on an MRI scan ordered today.
ANS: A
This patient shows objective clinical evidence of clinical lesions and has had one attack. Diagnosis in this patient requires a second clinical attack or two MRI scans showing a new lesion over time. A single attack is not diagnostic. If an MRI scan is performed now, a second scan may be done at any time later to look for the development of new lesions; it is not necessary to do the second MRI scan at the time of another attack. An MRI scan done today may not be definitive, because it does not show dissemination over space or time.
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