Multiple Sclerosis Diagnosis
A Case Study
Multiple Sclerosis (MS) is an inflammatory disease of the
Central Nervous System (CNS) - that's the brain and spinal cord. Predominantly,
it is a disease of the "white matter" tissue. The white matter is made up of
nerve fibers which are responsible for transmitting communication signals both
internally within the CNS and between the CNS and the nerves supplying rest of
the body.
In people affected by MS, patches of damage called plaques or lesions appear in
seemingly random areas of the CNS white matter. At the site of a lesion, a nerve
insulating material, called myelin, is lost. Clinically, MS is a hard condition to characterize because it
is very unpredictable and variable. Depending on which areas of the CNS are
affected and how badly they are damaged, the type and severity of symptoms can
vary greatly.
No two people get MS in exactly the same way and the expression of each
individual's disease is as unique as their fingerprints. However, the different
courses of the disease, both within an individual and within the whole
population, principally differ in their timing, location and severity.
Underneath similar processes (including demyelination and sometimes other forms
of nerve degeneration) are going on.
Although recent research indicates that the biochemical make-up of lesions may
vary between different forms of the disease, this is not the reason why people
with MS have such widely differing symptoms - it's because nerve damage to
one site usually causes completely different symptoms than damage to another.
In general, people with MS can experience partial or complete loss of any
function that is controlled by, or passes through, the brain or spinal cord.
Case Study
09/00/91 Patient presents to Athens
Medical Center, Dr. Marshal Long with the following symptoms: tingling in
the groin, upper thighs and palms while bending chin towards chest, and
sensitivity to heat. C-spine x-rays results are normal. Symptoms
eventually went away. Possible diagnosis of Lhermitte's Sign.
06/00/95 Patient was assigned to
physical therapy with John Williams in Princeton, WV for foot pain and was
taught stretching exercises. Also went to Dr. Bear of Bluefield Regional
Hospital for stress test due to turning red at exercise class. The symptom
of heat sensitivity had returned. Stress test was normal.
11/00/95 Patient experiences symptoms
of right arch pain when jogging, tingling in palms, tingling down groin when
bending chin towards chest, heat sensitivity, food "catching" in throat - seemed
to be swallowing wrong, feet stinging, and difficulty holding bowel movements.
The patient contracted her first urinary tract infection. Symptoms went
away within three months.
12/14/98 Patient has left hip and lower
back pain which seemed to be associated with sciatica. Other symptoms
include tingling, stinging in arms, groin and thighs. She had difficulty
walking and couldn't go to work. Had x-rays done.
12/20/98 Patient undergoes MRI of back
with no contrast.
01/08/99 Patient undergoes MRI of the
brain with Galadium contrast resulting in a referral to Neurosurgeon, Dr. Shah
Siddiqi.
01/26/99 Patient is seen by Dr. Siddiqi
and referred to Neurologist, Dr. William Merva. The referral letter states
"over last two months" had bilateral hand tingling, numbness and abnormal
feelings of feet, numbness of lateral aspect of right thigh, generally weak and
tired, reduction in memory, and abnormal sensation in back of scalp.
Patient was taking Prednisone for an allergic reaction.
02/01/99 Patient is seen by Dr. Merva
for evaluation.
02/04/99 Patient undergoes testing for
evoked potentials. Diagnosis of Carpal Tunnel Syndrome is given and hand
splints prescribed.
02/10/99 Patient undergoes cervical MRI
with contrast and has an allergic reaction to the contrast later that night.
02/15/99 Patient is given a definite
diagnosis of Multiple Sclerosis and prescribed 3 days IV SoluMedrol.
Carpal Tunnel is cured. Patient did not take a tapering-off dose of
Prednisone.
03/16/99 Patient's right knee is
turning back, hyper extending and she is having spasms in her right calf muscle.
These symptoms lasted for five days. Patient was prescribed Ketoprofen but
took Motrin instead.
04/06/99 Patient began administering an
Avonex injection to herself once a week.
06/03/99 Patient is seen by Theodore P.
Werblin, M.D.,P.C. in Princeton, WV due to having pain in the right eye with
blurry vision and floaters. Eye tests prove negative.
06/29/99 Patient is seen by Joel C
Morgenlander, M.D. of Duke University Medical Center for a second opinion and
diagnosis of Multiple Sclerosis is confirmed.
Current: 2004
Patient still experiences severe fatigue, difficulty walking,
sensory problems, bowel and bladder complications, mental impairments,
difficulty with sleep patterns, heat sensitivity, sexual dysfunction, and social
issues.
Patient is now treated for MS by Dr. Virginia Simnad at
University of Virginia. Dr. Simnad specializes in chronic progressive
neurological diseases.
Patient's current medications are Avonex Injection once a week,
Ditropan, Baclofen, Zocor, Nasonex, Ibuprofen, Metamucil, Claritin, Robitussin
and a Daily Multivitamin. She experiences side effects from some of these
medications such as flu-like symptoms from the Avonex, dry mouth from the
Ditropan, and increased fatigue from Baclofen. Although she has serious complicatioins with this disease she is able to lead a full and happy life with her family and friends. She participates in church functions, exercises by walking more than 2 miles daily and attends yoga lessons. She has a very positive outlook on everything in her life even though MS makes her life very difficult.
The revelation is that the patient is my mother. It scares me to
think that she is dying of this horribly slow and debilitating disease.
She is very dear to my heart and I love her so much. I want to thank her
for being my subject for this write-up. I hope that she will continue on
her journey with multiple sclerosis with the positive attitude that she now has
and remain strong throughout.
Source:
http://www.multiple-sclerosis.org
Mary Bragg, Multiple Sclerosis Victim