Case Study : The Nervous System

 Case Study #6a Neurologic System: Multiple Sclerosis Patient: Myrtle Newly Diagnosed, (25 years old), Social History: Homeless, Unemployed, Single, Nonsmoker; no ETOH (ETOH is an acronym for ethyl alcohol); no illicit drugs On line college student-struggles to understand material RRMS (Relapse-Remitting Multiple Sclerosis) Symptoms 2006: blurred & double vision 2013: Double vision; urinary urgency; poor attention 2012: Numbness in both legs Diagnosis: RRMS – Relapse-Remitting Multiple Sclerosis (2 episodes of neurological symptoms referable to the CNS, separated in space and in time) Memory problems past 6 months; fatigue; heat intolerance; problems with balance Prevalence by Cognitive Domains Memory 40% Information Processing 35% Attention/concentration 30% Problem Solving 20% Visuospastial Abilities 20% Verbal fluency 10% Multiple domains (average)22% Supporting the Diagnosis Findings on exam: –left INO internuclear ophthalmoplegia abbreviation: INO Loss of the normal paired movements of the eyes when tracking an object to the left or right. An INO is marked by the failure of one eye, e.g., the left, to cross the midline during an attempt to see an object on the opposite side of the body, e.g., the right. –vertical nystagmus (a repetitive, involuntary, to-and-fro oscillation of the eyes. It may be physiological or pathological and may be congenital or acquired.), right ptosis, –mild LE ataxia (the loss of full control of bodily movements) with tandem gait MRI Brain and T spine –Multiple enhancing white matter lesions –High T2 signal in the right optic nerve –Rim enhancing lesion at T6-7 CSF –Bands notes in CSF and not in serum Medications IM Interferon beta-1a Gabapentin 300mg tid Oxybutynin Chloride 5mg tid