American Board of Internal Medicine (ABIM) Certification Practice Exam

What defines a pseudorelapse in multiple sclerosis?

1. A permanent worsening of baseline symptoms

2. A temporary worsening due to physiological stressors

3. A new neurological symptom not related to previous symptoms

4. A complete remission of all symptoms

The correct answer is: A temporary worsening due to physiological stressors

In multiple sclerosis (MS), a pseudorelapse is characterized by a temporary worsening of symptoms that arises in response to physiological stressors, such as infections, heat, or emotional stress. This phenomenon occurs because the underlying demyelination in MS can be exacerbated by external factors, leading to transient neurological deficits that mimic a relapse but are not due to new disease activity. Recognizing the effect of physiological stressors is crucial in the management of MS, as these triggers can lead to fluctuations in symptoms without indicating a new active phase of the disease. These temporary changes typically resolve once the stressor is addressed, distinguishing pseudorelapses from actual disease progression where neurodegenerative changes would lead to more persistent symptoms. In contrast, a permanent worsening of baseline symptoms indicates a true relapse or disease progression, while a new neurological symptom not related to previous symptoms could suggest a new attack or a different issue entirely. A complete remission of all symptoms reflects a state of recovery rather than a temporary exacerbation.