Question

You have been asked to see D. V. in the Neurologic Clinic on referral from his internist, who thinks his patient is having symptoms of multiple sclerosis (MS). He is a 20-year old man who has experienced increasing urinary frequency and urgency over the past 2 months. Because his female partner was treated for a sexually transmitted disease, D. V. also underwent treatment, but the symptoms did not resolve. D. V. has also recently had 2 brief episodes of eye “fuzziness” and associated with diplopia and brightness. He has noticed ascending numbness and weakness of the R arm with inability to hold objects over the past few days. Now he reports rapid progression of weakness in his legs.

1. MS is an inflammatory disorder of the nervous system causing scattered, patchy demyelinization of the CNS. What does myelin do? What is demyelinization?
2. MS is characterized by remissions and exacerbations. What happens to the myelin during each of these phases?
3. Isn’t D. V. too young to get MS? What is the etiology?
4. What assessment data from the case study caused the physician to suspect a possible diagnosis of MS?

Diagnostic tests are often done to rule out other disorders with similar symptoms. A diagnosis will be made when other disorders have been ruled out, when the patient has 2 or more exacerbations, there is slow, steady progression, and/or the patient has 2 or more areas of demyelinization or plaque formation.

1. What are 4 common diagnostic tests you can begin to teach D. V. about?
2. D. V. asks you, “If this turns out to be MS, what is the treatment?”
3. As part of your teaching plan you want D. V. to be aware of situations or factors that are known to cause an exacerbation of symptoms. List four.
4. The National Multiple Sclerosis Society, 733 3^rd Ave., 6^th Floor, New York, NY 10017-3299 (1-800-344-4867) is a great resource for D. V. What are some resources available in the community that D. V. may need referrals to?

D. V. confides in you that he tried to commit suicide at the age of 14 when his parents got a divorce. He tells you that he knows his girlfriend hasn’t been faithful but he is afraid of living alone. He admits that she occasionally hits him, but he’s afraid if he tells her about his M. S. diagnosis she’ll leave him for good. You recall seeing yellowish bruises on his arms when you took his admission blood pressure.

1. What are you going to do with this information?
2. In view of his personal history and current diagnosis, what two critical psychosocial issues are you going to monitor for in his follow-up visits?

D. V. took advantage of his time with the psychiatric nurse specialist, joined a local MS support group, and told his girlfriend to move out. He later married a woman from the support group.

Answer 1

Answer: Myelin enables the nerve impulses to travel fast to the Central nervous system. In the case of the demyelinization, it is a kind of response which occurs due to the myelin nerve inflammation. This results in the separation of the myelin. The myelin gets seperated from the axon cylinder. This separation causes nerve transmission interruption.

The restoration of the transmission of nerve impulse occurs when the myelin is regenerated during the remission. In this phase the symptoms gets reduced. This inflammation may cause exacerbations. It may also cause destruction of the myelin which would be irreversible. The existence of the plaque damages the CNS.

The damage that occurs to the motor as well as sensory control centres lead to this urinary symptoms. The numbness, tingling as well as weakness occurs during to the damage to the sensory nerve and motor. This is the ocular symptoms. The damage to the cerebellar region results in to the other symptoms.

The assessment data from the case study caused the physician to suspect a possible diagnosis of MS are:

• CT scans reveals the lesions and presence of plaque.
• The presence of the CSF fluid.
• The speed of the nerve transmission.