Multiple Sclerosis

Presentation:
RJP, a 26 year old woman, came to the ER complaining of numbness from the hips down and difficulty walking. She stated her feet have been numb for a few weeks and she woke up this morning feeling numb from the hips down and was having trouble with walking. No prior medical history and no recent infections or illness. Vital signs stable.

Diagnosis:
Labs were sent; the only abnormal lab was WBC at 15. The medical team was able to rule out Epstein-Barr virus and Lyme disease. MRI of the brain was done and there was presence of plaques and scarring. The medical team consulted neurology and they performed a lumbar puncture (LP). The patient was started on IV steroids pending results of LP. The spinal fluid came back positive for oligoclonal bands, inflammation-related proteins of the nervous system. Neurology was able to diagnose the patient with having multiple sclerosis.

Treatment & Outcome:
RJP was started IVIG infusions and glatiramer acetate injections once a day. She also worked with physical therapy once a day. The medication will take a few weeks to fully take effect; RJP was starting to have feeling back in her thighs. As her symptoms slowly started to improve she was eventually discharged to an acute rehab facility.

Case created by Rachel Petrus, 2012.