A 45-year-old man with known multiple sclerosis presents with acute onset of bilateral leg weakness, urinary retention, and loss of perianal sensation. Vital signs show BP 128/82, HR 88, RR 16, temperature 37.2°C, and SpO2 98% on room air. MRI of the thoracic spine reveals a longitudinal T2-hyperintense lesion extending 3 vertebral segments with central cord involvement. Serum vitamin B12 level is normal. He denies recent fever or bowel dysfunction. Which of the following is the most appropriate next step in management?
- A)Lumbar puncture for CSF analysis
- B)Interferon-beta therapy
- C)Plasmapheresis alone
- D)Observation with supportive care
- E)High-dose intravenous methylprednisoloneGABARITO
Explicação
Acute myelitis presenting with paraplegia, sensory level, and urinary retention requires emergent high-dose IV corticosteroids to reduce inflammation and prevent permanent neurological damage. This is a demyelinating exacerbation requiring acute anti-inflammat... Ver explicação completa e trilha adaptativa →