| QUIZ: None so blind as those that will not see! *solved* |
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| Sunday, 22 May 2011 22:38 |
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Mr. Richardson is 36 year old architect who presents with sudden blindness in his left eye. He claims he had been experiencing trouble with vision for several days and found he was blind in his left eye. He has never before had any trouble with his vision. He mentioned that 2 years ago he had trouble with balance and walking for 2 weeks, has had several problems with urinating and had to be catheterized twice. He's a non-smoker. Both parents are living, in their sixties, and in good health. He has two younger brothers, both in good health, neither with chronic medical problems. What disease could he suffer from? and how can you confirm it? |
Comments
no test is pathognomonic but clinical diagnosis by dissiminated lesion in place and time
CSF for oligoclona bands
delayed visual , auditory and sensorymotor evoked potential
Here's the patient's full story:
The findings from his neurological exam are:
Focal sensory loss of lower extremities.
Mild spasticity of left arm upon movement.
Brisk deep tendon reflexes of knees and left biceps.
Bilateral Babinski sign.
His occular exam shows:
Ocular movements intact, no nystagmus.
Eye grounds unremarkable.
No opacification of lenses.
Left pupil sluggishly reactive to light.
The rest of PE is normal.
The patient's history and PE is highly indicative of Multiple Sclerosis for the reason you mentioned above, the sensory and motor lesions dispersed in space and time. So, in order to confirm MS we need to do a cerebral MRI and CSF analysis. The MRI showed multiple lesions of white matter
and the CSF elevated IgG and IgG index.
IgG index=(CSF IgG/serum IgG)x(serum albumin/CSF albumin)
Increase in both CSF IgG and IgG index indicates increased production of IgG within the CNS.
In addition, oligoclonal gamma bands were increased in CSF protein electrophoresis .
All that surely point only to one thing:MS.
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