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Washington University Experience | MYELIN (IMMUNE-MEDIATED) | MS - Schwannian CNS remyelination | 3A0 Case 3 History
Case 3 History ---- The decedent was a 33-year old man who died in January 2016 with evidence of hypertrophic cardiomyopathy; the patient’s father also had cardiomyopathy and died at age 24. The decedent also had a history of relapsing-remitting multiple sclerosis (RRMS) beginning in 2004. At that time he experienced bilateral leg numbness, ringing in his ears, and a spinning sensation, which lasted for 2 months. Of note, the decedent’s maternal uncle also had MS. An MRI of the brain and spine showed white matter lesions consistent with MS, supported by CSF studies. He was treated with Rebif (interferon beta-1a) since that time. Office notes from September 2013 describe an MRI with contrast showing no enhancing lesions, as compared with a prior MRI which had shown 20 enhancing lesions. Per report, the September 2013 MRI showed advanced parenchymal volume loss for age and a markedly thinned corpus callosum, as well as a multitude of T2 hyperintensities involving subcortical and periventricular white matter as well as the pons, left middle cerebellar peduncle, and posterolateral medulla. The parenchymal lesions, which appeared acute in 2005, had evolved. Office notes from June 2015 document normal cranial nerve exam, normal mental status, and normal sensory exam. Balance and gait examination was notable for mild-moderate ataxia, with a negative Romberg test. Coordination showed “L>R mild dysmetria, but normal heel-to-shin movement. Reflexes were normal throughout. The notes specifically mention “strength good, balance good, no numbness or tingling, no visual loss, no double vision, no vertigo, no Lhermitte’s, no bladder urgency, no constipation and no fatigue.”
