Announcements: Neuromuscular section updated with more questions.


  • Symptoms (onset, duration, progression)?
  • If suspected MS, other neurologic symptoms they may have had in the past which resolved?
  • Recent signs of infection (fever, chills, URI symptoms, dysuria)?
  • If known MS, have they ever had these exact symptoms before? This may suggest recrudescence due to systemic issue

 If known MS, MS history:

  • when and how they were diagnosed
  • type of MS (RRMS, PPMS, SPMS, NMO, etc.)
  • what MS medication are they on and compliance
  • last exacerbation, last round of steroids
  • baseline deficits or character of their past flares


Vitals, full physical looking for signs of infection and full neurologic exam and specifically looking for APD / optic nerve pallor, INO, Lhermitte’s sign, spasticity / hyper-reflexia


ED WORKUP:  obtain UA / Ucx, CXR, basic labs



  • If suspected exacerbation:
  • admit to neurology
  • may need to consider  changing or starting a disease modifying agent (discuss on rounds with attending)
  • Make sure to call there neurologist if they are private
  • consider steroids (solumedrol 1gram IV daily x 5 days) or IVIG
  • if starting steroids, also start on PPI / H2 blocker and insulin sliding scale
  • MRI with and without contrast of pertinent areas (brain, spine)
  • PT/OT

If suspected new diagnosis:

  • Full differential needs to be considered and ruled out, possible further testing includes MRI brain and spine w/wo, ACE, Lyme, anti-NMO, RPR/VDRL, vasculitic and autoimmune panel, CSF for basic studies and oligoclonal bands, myelin basic protein, IgG index, Lyme, ACE
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