Neuroimaging And Cerebrospinal Fluid Analysis Practice Test

A 33-year-old woman reports 2 episodes of neurologic symptoms over 8 months. The first was painful vision loss in the left eye that improved over weeks. The second is 5 days of numbness and tingling in both legs with unsteady gait. She has fatigue and heat sensitivity. No fever. Exam shows decreased visual acuity in the left eye with a relative afferent pupillary defect, mild spasticity in both legs, hyperreflexia, and an upgoing plantar response on the right. Sensation to vibration is reduced in the feet. CBC and CMP are normal. MRI brain shows multiple ovoid periventricular T2 hyperintense lesions; one lesion enhances with gadolinium. A lumbar puncture is performed to support the suspected diagnosis and guide counseling about disease-modifying therapy.

A 24-year-old woman presents with 2 days of fever, severe headache, and progressive confusion. She has nausea and vomited twice. Past history includes recurrent oral HSV-1 lesions. Medications: oral contraceptive only. On exam, T 39.4°C, BP 118/72 mm Hg, HR 112/min. She is disoriented to place and has word-finding difficulty. Cranial nerves are intact. She has mild right arm weakness (4/5) and hyperreflexia on the right. Neck is mildly stiff. CBC shows WBC 14,800/µL. Basic metabolic panel is normal. Concern for CNS infection is high, but focal neurologic deficits raise concern for increased intracranial pressure or a focal lesion. The team must decide on the safest next diagnostic step before CSF sampling to avoid herniation risk and to support empiric management decisions.