Multiple sclerosis

Clinical vignette
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By Anthony T Reder MD

 A 28-year-old woman began to stumble when walking. Her right leg was slightly stiff and weak, especially after exercise and hot showers. These symptoms developed over 3 days and gradually disappeared over 4 weeks.

She was on the college swim team before these symptoms arose. There, when she was 21 years old, she developed a unique and extreme type of fatigue that differed from the usual fatigue after intense swimming workouts. This disappeared after several weeks, but reappeared again when she was 28 years of age. One maternal aunt had multiple sclerosis.

An MRI scan showed multiple periventricular lesions. Her spinal fluid had elevated IgG levels and 3 oligoclonal bands (normal, less than 2).

One year later, 10 days after a “cold,” she developed blurred vision in her right eye and her visual acuity dropped to 20/200. She had moderate pain behind her eye when she looked to either side. The pain and visual loss gradually disappeared over 6 weeks. Two years later, she noticed that both legs were becoming gradually weaker and spastic and she needed to run to the bathroom nearly every hour to urinate. These symptoms slowly progressed over the next 10 years, with occasional exacerbations affecting other areas of the brain. Interferon-beta was begun in the middle of the relapsing and progressive phase and the frequency of attacks and rate of progression slowed. She is now walking with the help of bilateral ankle and foot orthoses. She has been aided by minor modifications of her workplace and by treatment of multiple sclerosis symptoms, and she continues to work as a business executive.

In This Article

Historical note and nomenclature
Clinical manifestations
Clinical vignette
Pathogenesis and pathophysiology
Differential diagnosis
Diagnostic workup
Prognosis and complications
References cited