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Washington University Experience | MYELIN (IMMUNE-MEDIATED) | MS - Brainstem & Cerebellum | 15A0 Case 15 History
Case 15 History ---- The patient was a 46 year old right-handed man with chronic progressive multiple sclerosis, leading to blindness and quadriplegia. He was hospitalized following two days of congestion and subsequent mental status changes and died of urinary tract infection, pneumonia, and presumptive sepsis. The patient began having neurological symptoms in the late 1970s with difficulty in equilibrium followed by left lower extremity weakness resulting in a diagnosis of MS in 1980 at age 27. Although detailed records are unavailable, it appears that his initial MRI showed multiple white matter plaques and CSF analysis consistent with MS. He was treated with multiple medical regimens including Solumedrol, cyclosporine, and Cytoxan/ACTH. He progressed to quadriparesis in the late 1980s. He was functionally blind and had exacerbations that included internuclear ophthalmoplegia and poor acuity. He developed seizures in 1994. He had long time swallowing problems resulting in placement of a G-tube two years prior to his death. He had had a two-day history of congestion and mental status changes on the day of admission. He was febrile. A chest x-ray showed bilateral interstitial infiltrates, possibly secondary to chronic aspiration. He had a white blood cell count of 24.4 and was begun on Ceftriaxone and Vancomycin. Clindamycin was later added but he became hypotensive and died.
