Question

D.V., a 32-year-old man, is being admitted to the medical floor from the neurology clinic for evaluation of his symptoms. D.V. has experienced increasing urinary frequency and urgency over the past 2 months. Because his female partner was treated for a sexually transmitted infection, D.V. underwent treatment, but the symptoms did not resolve. D.V. has also recently had two brief episodes of eye “fuzziness” associated with diplopia and flashes of brightness. He has noticed ascending numbness and weakness of the right arm with the inability to hold objects over the past few days. Now he reports rapidly progressing weakness in his legs along with blurred, patchy vision. D.V denies any allergies to medications, as well as any significant past medical history. However, he does report the occasional cold during the winter months.

Determine what possible diagnosis D.V.will have from the evaluation of his symptoms and what do each of the symptoms mean and how do they relate to his diagnosis?

Answer 1

Diagnosis: multiple sclerosis

In MS, there is an autoimmune response that attacks the protective sheath (myelin) that covers nerve fibers and causes it degeneration.causing scattered, patchy demyelination of the CNS (central nervous system). Myelin helps the nerve impulses to travel fast through the CNS. Demyelination resulting in damaging the myelin and interruption of nerve transmission causing the symptoms

ocular manifestations include internuclear ophthalmoplegia and nystagmus that will cause diplopia, oscillopsia,(the sensation that the surrounding environment is constantly in motion) blurred vision, loss of stereopsis, and reading fatigue. There is evidence to suggest a significant and broad reduction in both contrast sensitivity and color perception.

Urinary symptoms, ie urinary frequency, and urgency over the past 2 months could be secondary to damage to motor and sensory control centers. Hence the history of occasional cold during the winter months, Urinary symptoms, and illness of female partner to be considered in this aspect

motor and sensory symptoms:The right arm numbness, tingling, and weakness could be due damage to the motor and sensory nerve tracts

There have been some documented evidence to suggest that variety of viruses could be linked to MS, including Epstein-Barr, the virus that causes infectious mononucleosis. Hence the history of occasional cold during the winter months, Urinary symptoms, and illness of female partner to be considered in this aspect