Approach to differentiating lesions (spinal cord) Quiz: Ace Your Exams

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A 45-year-old woman presents to the emergency department for evaluation of worsening mid back pain and numbness and tingling in both legs for the past two days. This morning, the patient tripped while going up the stairs and has felt progressively weaker throughout the day. She has not voided since the previous evening. Medical history includes multiple sclerosis managed with teriflunomide. Temperature is 37.0°C (98.6°F), pulse is 80/min, respirations are 15/min, and blood pressure is 118/70 mmHg. On exam, there is symmetric drift in both lower extremities and impaired proprioception, pain, temperature, and vibration sense in both legs. Upper extremity strength and sensation are normal. Which of the following tests confirms the diagnosis?

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Serum and cerebrospinal fluid (CSF) analysis for oligoclonal banding

Magnetic resonance imaging (MRI) of the thoracic spine with and without contrast

Magnetic resonance imaging (MRI) of the lumbosacral spine with and without contrast

Magnetic resonance imaging (MRI) of the cervical spine with and without contrast

Magnetic resonance imaging (MRI) of the brain with and without contrast