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Washington University Experience | MYELIN (IMMUNE-MEDIATED) | MS - Brainstem & Cerebellum | 16A0 Case 16 History
Case 16 History ---- This is a 59 year old man with a long history of multiple sclerosis and recurrent hospital admissions for pneumonia. The patient reportedly had difficulty with ambulation, feeding himself, and speaking. The patient has an approximately 14 year history of multiple sclerosis but no other significant medical illness and no previous surgeries. He was treated with Baclofen. The physical exam was unremarkable except for mild tachypnea. Neurologic examination showed the patient was awake, alert, and oriented X3 with slurred, but otherwise appropriate, speech. Cranial nerves were reportedly unremarkable. Exam revealed 1/5 strength throughout all four extremities and diffuse sensory paresthesias. The deep tendon reflexes were markedly decreased and symmetric. Due to the patient's progressive course of multiple sclerosis, the family and the patient requested that no further interventions be done. Over the course of the next few months, the patient developed progressive weakness and difficulty with activities of daily living. He began to develop hallucinations which were ascribed to his multiple sclerosis. The patient continued with marked anorexia and failure to thrive. He had a long-standing neurogenic bladder and recurrent urinary tract infections requiring periodic antibiotics. On mid-November 1995, the patient began to develop increased coughing, diaphoresis and temperature of up to 38.5° C. The patient had a significant progressive productive cough and marked anorexia and began to have significant respiratory distress. Due to the patient's previously documented wish and the family's wishes, no interventions were pursued, and the patient expired in mid-November.
