Which of the following is the most likely diagnosis? A 27-year-old woman comes to the physician because of a 2-year history of sporadic vision and a 1-year history of intermittent numbness and tingling in her ARMS. The symptoms became more severe 5 days ago after a 4-day visit from her husband’s parents. During the past year, she also has had four episodes of urinary incontinence. Physical examination shows mild dysarthria. On mental status examination, she has a mildly worried mood and a reactive effect. MRI of the brain shows a few small, scattered, nonspecific white-matter plaques.
A. Complex partial seizure disorder
B. Conversion disorder
C. Huntington disease
D. Multiple sclerosis
E. Panic disorder without agoraphobia
The correct answer to this question is D, Multiple sclerosis. Also known as MS, multiple sclerosis impacts the immune system. As the condition occurs, it slowly eats away the protection that covers the nerves. The young woman is experiencing a number of symptoms that resemble MS, including the loss of vision, and numbness.
This is why the doctor would more than likely diagnose her with multiple sclerosis. Though MS is a rare disease, tests do need to be performed to ensure a patient has this condition. Once it is proven she has MS, the doctor will require her to go to therapy and take certain medications to ease the symptoms.
When a patient goes to see a doctor, usually they have been experiencing problems for quite a while and they want to seek some answers from the experienced physician. They may need to be prescribed medication or undergo surgery or the problem they are having could increase and get worse. In this case, the young woman reveals that she is having certain symptoms for quite a while and they include vision issues, numbness and tingling.
She also has trouble when she goes to the bathroom. The doctor may take some blood samples to determine exactly what is wrong besides having the patient explain her symptoms and the period of time that she has had these symptoms. He probably would diagnose her as having multiple sclerosis.
1. multiple sclerosis -ms is approximately threefold more common in women than men. the age of onset is typically between 20 and 40 years (slightly later in men than in women), but the disease can present across the life span. the onset of ms may be abrupt or insidious. symptoms may be severe or seem so trivial that a patient may not seek medical attention for months or years. indeed, at autopsy, approximately 0.1% of individuals who were asymptomatic during life will be found, unexpectedly, to have pathologic evidence of ms. similarly, in the modern era, an MRI scan obtained for an unrelated reason may show evidence of asymptomatic ms. symptoms of ms are extremely varied and depend on the location and severity of lesions within the CNS. examination often reveals evidence of neurologic dysfunction, often in asymptomatic locations. for example, a patient may present with symptoms in one leg but signs in both.
mri has revolutionized the diagnosis and management of ms; characteristic abnormalities are found in >95% of patients although more than 90% of the lesions visualized by mri are asymptomatic. an increase in vascular permeability from a breakdown of the bbb is detected by leakage of intravenous gadolinium (gd) into the parenchyma. such leakage occurs early in the development of an ms lesion and serves as a useful marker of inflammation. gd enhancement persists for approximately 1 month, and the residual ms plaque remains visible indefinitely as a focal area of hyperintensity (a lesion)
relapsing/remitting ms (rrms) accounts for 85% of ms cases at onset and is characterized by discrete attacks that generally evolve over days to weeks (rarely over hours). there is often complete recovery over the ensuing weeks to months. however, when ambulation is severely impaired during an attack, approximately half will fail to improve. between attacks, patients are neurologically stable.
weakness of the limbs may manifest as loss of strength, speed, or dexterity, as fatigue, or a disturbance of gait. exercise-induced weakness is a characteristic symptom of ms. the weakness is of the upper motor neuron type and is usually accompanied by other pyramidal signs such as spasticity, hyperreflexia, and Babinski signs. occasionally a tendon reflex may be lost (simulating a lower motor neuron lesion) if an ms lesion disrupts the afferent reflex fibers in the spinal cord
optic neuritis (on) presents as diminished visual acuity, dimness, or decreased color perception (desaturation) in the central field of vision. these symptoms can be mild or may progress to severe visual loss. rarely, there is complete loss of light perception. visual symptoms are generally monocular but may be bilateral. periorbital pain (aggravated by eye movement) often precedes or accompanies the visual loss. an afferent pupillary defect is usually present. funduscopic examination may be normal or reveal optic disc swelling (papillitis). pallor of the optic disc (optic atrophy) commonly follows on. uveitis is uncommon and should raise the possibility of alternative diagnoses such as sarcoid or lymphoma.