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Washington University Experience | MYELIN (IMMUNE-MEDIATED) | MS - Shadow Plaque | 6A0 Case 6 History
Case 6 History ---- The patient was a 28 year old female who was well until she developed tingling in her left arm and trunk which lasted for 5-6 weeks followed 4 and 5 years later by a similar presentation which resulted in decreased dexterity of the right hand. Visual evoked responses were abnormal. She returned to good health until a year later when she developed intense tingling in the lower extremities and left hand accompanied by weakness. Cranial nerve examination was unremarkable except for a right Marcus Gunn pupil. Sensation was decreased to pin prick on the left lower extremity and left trunk. Vibratory and joint position sense were impaired in the lower extremities. Examination of the motor system was remarkable for mild spasticity at the right wrist and left elbow and in both lower extremities. Strength was 5/5 in the upper extremities, but in the range of 1-3/5 in the right lower extremity and 3-5-/5 on the left. Muscle stretch reflexes were 3+ in the upper extremities and 4+ at the knees and ankles with clonus being elicited easily at the knees and the ankles. The plantar responses were extensor bilaterally. Cerebellar examination was unremarkable. The clinical diagnosis was multiple sclerosis. Lumbar puncture demonstrated an opening pressure of 150 mm water, 7 cells without acid, l cell with acid, glucose 60/96, protein 24. On the second hospital day, she was begun on ACTH therapy, receiving 80 units over 4 hours intravenously. On the third hospital day, she complained of a severe headache and was treated with Tylenol. After reclining, she became unresponsive. Blood pressure was unobtainable. She was found to have fixed and dilated pupils, gasping respirations, and faint pulse. Within minutes, respirations ceased, as did spontaneous heart rate. Vigorous cardiopulmonary resuscitation was unsuccessful and the patient expired.
