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Washington University Experience | MYELIN (IMMUNE-MEDIATED) | MS - Optic Nerves | 4A0 Case 4 History
Case 4 History --- This is a 33 year-old female with a history of multiple sclerosis diagnosed in 1997 at the age of 19. It is unclear what her presenting symptoms were but by the time she was first seen here in 2004, she was significantly disabled. On examination, she had visual acuity of 20/200 and 20/400 in the right and left eyes, respectively. She had upgaze nystagmus and dysarthria. Her motor exam was notable for spastic quadriplegia. In addition, she was ataxic in all four extremities with significant truncal ataxia and was unable to walk. The treating physician felt that she had secondary progressive multiple sclerosis. MRI of the brain revealed extensive periventricular white matter lesions both supra- and infratentorial without active contrast enhancement but notable cerebral and cerebellar atrophy. She had been previously treated with mitoxantrone without benefit and interferon therapy was commenced, also without benefit. The patient was completely bed-bound by 2005. She returned to the hospital with complaints of shortness of breath and was discovered to have dilated cardiomyopathy with an ejection fraction of only 15%, and since she had just delivered a child, was presumed to be post-partum in etiology. She was treated medically for congestive heart failure but returned to the hospital on multiple occasions for pneumonia and sepsis. Her most recent hospitalization was for complaints of dyspnea. She was felt to have pneumonia and was intubated for respiratory distress. Upon arrival in the medical intensive care unit she suffered repeated cardiac arrests with pulseless electrical activity before her family asked that further resuscitative efforts be suspended and she expired.
