Multiple Sclerosis

Case #339: MRI Brain, 1/19/95: Probable demyelinating disease.

UIHC: 9501850-6

DOB:12/10/68

IN: MNT

DOE: 1/19/95

CC: Binocular Horizontal diplopia.

Hx: This 20y/o LHF began experiencing difficulty moving her right eye laterally 10 days prior to 1/19/95. She had associated binocular horizontal diplopia upon rightward gaze. The double viosion resolved when she covered one eye. She coincidently began to experience LLE tingling form the knee down and left facial tingling. 7 days prior to 1/19/95 to also develop LUE tingling in the forearm and hand. The tingling sensation worsened during the evening and had waxing-waning course. She denied any incontinence, dysphagia, or dysphasia. She has had recent fevers, chills, nightsweats, lymphadenopathy, SOB or CP. Her symptoms did not worsen after exercise or hot showers.

In 1989, she experienced a 3 month period of near urinary incontinence. In 7/94, she experienced a pressure sensation about her left eye upon leftward gaze. These symptoms since resolved.

MEDS: Oral Birth control pills. No allergies.

PMH: 1)Peptic Ulcer disease dx 1979, treated with Tagamet for 4-5 years. 2) Migraine headaches which began in late childhood or early adolescence. The HAs are throbbing and holocranial in character. Last HA occured 6 months ago.

FHX: MGM with Parkinsons disease. No h/o multiple sclerosis in the family.

SHX: College graduate and high school teacher. Smokes 1/2pack cigarettes per day for 10 years. Occasional alcohol consumption. Denies illicit drug use.

EXAM: BP117/58 HR84 RR12 36.9C

MS: unremarkable.

CN: Decreased lateral movement OD with coincident horizontal diplopia on rightward gaze. No papilledema or RAPD. The rest of the CN exam was unremarkable.

Motor: 5/5 strength throughout with normal muscle tone and bulk.

Sensory: unremarkable.

Coord: unremarkable.

Station: mild LUE pronator drift. No Romberg sign elicited.

Gait: normal.

Reflexes: 2/2 throughout all extremities. Plantar response was equivocal on left and flexor on right.

Gen Exam: unremarkable.

COURSE: Urinalysis, GS, CBC were unremarkable. MRI Brain, 1/19/95, revealed multiple areas of increased signal within the white matter tracts of the brain stem and cerebral hemispheres. There is a large(1cm) ovoid lesion with associated edema in the right perventricular deep white matter tract. Smaller lesions are seen bilaterally in the perventriccular and trigonal area. There is a single, 5-8mm lesion within the right temporal tip and at least 3 separate lesions within the body of the pons near the CN 6 nucleus. These finding were suggestive of demyelinating disease. Lumbar puncture, 1/20/95, revealed: CSF Glucose 61, Serum Glucose 76, CSF Protein 49, Serum Protein 7.3, WBC 26(23lymphocytes, 3 histiocytes), RBC O, CSF IgG 10.5(normal<6.2), CSF Albumin 22.3(normal 14.1-20.0mg/dl), CSF IgG index 1.3(normal,0.7), Serum Beta-2 microglobulin 0.8(normal<1.9), CSF Beta-2 microglobulin 0.9(normal<1.9). She was given a 3 day course of Solumedrol 500mg IV q12hours and placed on a Prednisone taper for probable demyelinating disease. CSF Cytology negative.