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Washington University Experience | MYELIN (IMMUNE-MEDIATED) | MS - Cerebral Hemispheres | 7A0 Case 7 History
Case 7 History ---- The patient was a 64 year old woman with a history of uterine cancer s/p hysterectomy, metastatic lung cancer, tobacco use, and relapsing remitting multiple sclerosis. Her initial symptom was right leg numbness in the late 1970s that resolved after 6 months. She was diagnosed with MS in 1985 after a bout of optic neuritis. Later symptoms included fatigue, tremor, loss of right upper extremity control, gait instability, transient sensory abnormalities including right face and left arm and leg numbness, and urinary urgency with incontinence. Treatments included steroids for exacerbations throughout the course of her illness and Avonex at least from 2002-03 until she discontinued it due to expense. Family history was positive for 2 cousins with MS. She presented in 12/09 to be evaluated for possible post-mortem CNS donation. At that time, exam was notable for visual acuity 20/40 OD and 20/50 OS and temporal pallor. Strength was 4/5 proximally in the bilateral upper and lower extremities, with decreased fine finger movements on the right and increased tone in the lower extremities bilaterally. She had mild intention tremor of the right upper extremity and decreased heel-knee-shin in the right lower extremity. Dysdiadokinesis was present in the left upper extremity. Stance and gait were wide based and she frequently held onto the wall when walking. Reflexes were 3+ throughout, but brisker in the left upper extremity. She was diagnosed with stage 4 lung cancer in 9/09 after presenting with cough and shortness of breath. Pleural biopsy revealed stage 4 poorly differentiated non-small cell carcinoma that was TTF1 positive. Brain MRI reportedly demonstrated abnormalities thought to be consistent with MS, but no evidence of metastases. She began chemotherapy with Alimta in 10/09. Repeat imaging after 2 cycles raised concern for possible progression of lymphadenopathy. Radiation therapy was added in12/09 and completed in late January. In mid-February 2010, she complained of cough and deteriorated despite treatment with antibiotics. She was hospitalized with a post-obstructive pneumonia and respiratory failure. She declined intubation, and was discharged home with hospice. She died in March 2010.
