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Washington University Experience | MYELIN (IMMUNE-MEDIATED) | MS - Primary Progressive (PPMS) | 1A0 Case 1 History
Case 1 History ---- This patient was a 33 year old woman with a history of severe primary progressive multiple sclerosis (PPMS) diagnosed in 1985 based on clinical presentation and course, MRI and CSF studies. Early on her symptom complex chiefly involved brainstem and cerebellum. In April, 1991 she developed a generalized tonic/clonic seizure disorder, thought to be secondary to MS. She also had a history of renal artery stenosis diagnosed at age 19 requiring surgery, one episode of neuroleptic malignant syndrome in 3/91 secondary to Stellazine, and multiple UTIs consequent to MS-related cord dysfunction. Within the last year of her life she experienced multiple hospitalizations for the treatment of status epilepticus. In January, 1992, she began seizing at her nursing home and was brought into the ER later that morning, where seizure activity abated with IV Valium. Neurologically, she was unresponsive but without focal deficits, and was felt to be in a postictal state. Admission labs were notable for WBC 21.5 K (76 segs, 19 lymphs, 5 monos), normal electrolytes, urinalysis, arterial blood gas and CXR. Soon thereafter she became tachypneic with fever of l03°F. At that time CXR revealed a patchy infiltrate vaguely present at the left base, and Ciprofloxacin IV was started. Early the following morning the patient was found to be without respirations, pulse or BP. CPR was not attempted and she was pronounced dead following a 7 year course of MS.
