A 33-Year-Old Man with a History of Multiple Sclerosis Is

A 33-year-old man with a history of multiple sclerosis is brought to the emergency department due to new-onset leg weakness, numbness, and urinary incontinence.  In the past, he has had several acute exacerbations of multiple sclerosis, causing vertigo, vision impairment, and upper extremity weakness, all of which improved after glucocorticoid treatments.  A year ago he stopped taking disease-modifying therapy due to severe adverse effects.  His vital signs are within normal limits.  Mental status and cranial nerve examination are normal.  Muscle strength in the upper extremities is 5/5 and in the lower extremities is 3/5.  Pinprick sensation is decreased below the nipple.  Proprioception is decreased over both lower extremities.  Babinski reflex is present bilaterally.  MRI of this patient is most likely to reveal new plaques in which of the following locations?

A) Brainstem
B) Cerebellar hemispheres
C) Cerebellar vermis
D) Cervical spinal cord
E) Lumbosacral spinal cord
F) Supratentorial white matter
G) Thoracic spinal cord

Correct Answer:

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