A 29-year-old woman with relapsing-remitting multiple sclerosis presents during an acute relapse with painful visual loss in one eye and a new sensory level. Fundus shows optic disc swelling and MRI confirms new inflammatory lesions. She has no systemic contraindications to any therapy. Best next step?

• A Intrathecal methylprednisolone
• B Increase the dose of her disease-modifying therapy
• C Plasma exchange as first-line therapy
• D Intravenous methylprednisolone 1 g daily for 3 to 5 days ✓

Explanation

Acute MS relapses causing functional impairment such as optic neuritis or myelitis are treated with high-dose intravenous corticosteroids, typically methylprednisolone 1 g daily for 3 to 5 days, which shortens recovery time. Plasma exchange is reserved for steroid-unresponsive severe attacks, particularly neuromyelitis optica related. Adjusting the disease-modifying drug addresses long-term control, not the acute deficit.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.