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Washington University Experience | MYELIN (IMMUNE-MEDIATED) | MS - Chronic Active Plaque | 2A0 Case 2 History
Case 2 History ---- The patient was a 50 year old Caucasian woman who developed multiple sclerosis at 38, presenting in December of 1990 with diplopia in all directions which lasted for 6 weeks. In June 1991, diplopia recurred in combination with left > right leg weakness, fatigue, bladder urgency and retention, perineal hypersensitivity and worsening of her symptoms after hot showers (Uhthoff's phenomenon). She had concurrent depression. Her initial examination revealed right internuclear ophthalmoplegia, lower limb weakness and patchy sensory loss and hyperesthesia, and hyperreflexia with upgoing toes. MRI of the brain at this time (images are no longer available) revealed white matter lesions lateral to the left frontal horn, periventricular region, in the middle of the right cerebellar hemisphere, and in the right centrum semiovale. BAER and VER were normal. She was initially placed on oral steroids, with some resolution of symptoms. Lumbar puncture revealed an active MS pattern. The patient's family history was significant for an aunt with rheumatoid arthritis and a first cousin with multiple sclerosis. Her symptoms progressed to include urinary dysfunction, dysphagia, dysarthria, bilateral ataxia, worsening walking because of leg weakness, increased spasticity, culminating in the patient becoming wheelchair confined by 1995-96. She began to have shorter periods of remission after multiple courses of steroids. She developed chronic urinary tract infections, episodes of acute renal failure related to dehydration, and was s/p creation of an ileo conduit in 2001. She had episodes of leg edema, but no evidence of deep vein thrombosis. On 3/25/03 she presented to the ER in full arrest. Resuscitation was attempted and failed.
