Discussion Assignment:

• What is the effect of the demyelization on the nerves of an individual who has Multiple Sclerosis?
• Why are the medications appropriate?
• Why do you think females are at greater risk for MS?

Case Study:

Patient: Myrtle, Newly Diagnosed, (25 years old)

Social History: Homeless, Unemployed, Single,

Nonsmoker; no ETOH (ETOH is an acronym for ethyl alcohol); no illicit drugs

On line college student-struggles to understand material

Symptoms

2006: blurred & double vision

2013: Double vision; urinary urgency; poor attention

2012: Numbness in both legs

Diagnosis: RRMS – Relapse-Remitting Multiple Sclerosis

• • • (2 episodes of neurological symptoms referable to the CNS, separated in space and in time)
    • Memory problems past 6 months; fatigue; heat intolerance; problems with balance
    • Prevalence by Cognitive Domains
    • Memory 40%
    • Information Processing 35%
    • Attention/concentration 30%
    • Problem Solving 20%
    • Visuospastial Abilities 20%
    • Verbal fluency 10%
    • Multiple domains (average) 22%

Supporting the Diagnosis:

• • • Findings on exam:
      • left INO internuclear ophthalmoplegia abbreviation: INO Loss of the normal paired movements of the eyes when tracking an object to the left or right. An INO is marked by the failure of one eye, e.g., the left, to cross the midline during an attempt to see an object on the opposite side of the body, e.g., the right.
      • vertical nystagmus (a repetitive, involuntary, to-and-fro oscillation of the eyes. It may be physiological or pathological and may be congenital or acquired.),
      • right ptosis,
      • MRI Brain and T spine:
        • Multiple enhancing white matter lesions
        • High T2 signal in the right optic nerve
        • Rim enhancing lesion at T6-7CSF
        • Bands notes in CSF and not in serum

Medications

• IM Interferon beta-1a
• Gabapentin 300mg tid
• Oxybutynin Chloride 5mg tid