Demyelinating Diseases USMLE Step 1 Practice Question
A 52-year-old man presents with a 6-month history of progressive cognitive decline and personality changes. He reports gait disturbance and frequent falls. Vital signs: BP 138/82, HR 92, RR 16, Temp 37.2°C, SpO2 98% on room air. Examination reveals increased tone, hyperreflexia, and extensor plantar responses bilaterally. Brain MRI demonstrates asymmetric cortical and white matter atrophy with T2/FLAIR hyperintensities in periventricular regions. CSF protein is mildly elevated at 58 mg/dL. No fever or meningismus noted. Which diagnosis best explains these findings?
Answer choices
- AChronic hepatic encephalopathy
- BMetachromatic leukodystrophy
- CRelapsing-remitting multiple sclerosis
- DAdrenomyeloneuropathyCorrect answer
- EAlzheimer disease
- FAdult-onset Krabbe disease from galactosylceramidase deficiency
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