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What is not?

 Impossible is not a fact, its an opinion 

Multiple Sclerosis formerly disseminated sclerosis

May 20, 2010 by drsalman

Case Sheet

 A 35 year old male presenting to the ER with Sudden painless loss of vision in left eye and weakness of right leg.He is also complaining if difficulty in hearing and tingling sensation in right leg.In past he had one episode of loss of vison of same eye.Tis episode occured suddenly after he went for a hot both coming from Gym.

Examination of eye shows pae disc

There is sensorineural deafness in left ear

Right lower limb shows strenght of 3/5

Right lower lim shows loss of fine touch sensation.

There is severe pain on flexion of spine.

Case Discussion: 

Lesions of Multiple sclerosis are dissiminated in time and place.



Age 25- 35:20

Nothern european ancestory:20


Weakness of limbs:50

Visual loss:50

Tingling sesnsation/Loss of sensation:30

History of weakness ot visual loss,tingling in past:30



Ataxia 5:Shich like sensation on spine on flexion:20

Presence of two or more symptoms at different times which are not explanined by singele anotomic lesion:80

Oligoclonal bands on CSF 20

Abnormal VEP,AEP,SSEP:10

MRI showing periventricular plaque:60

If MS gradual and getting worse then Primary progressive

If MS relapsing and remitting then Relapsing Remitting

If MSgradually worsening with superimposed relapses Secondary progressive

If MS gradually progressive with later relapses Progressive relapsing

If MS severe and sudden acute episode

Acute MS give Methy prednisoslone

If SPMS-Give InfB Ib/Metoxantrone

If RRMS:GiveInfB Ib/Ia,Glatimer

Treat pain with carbamezepine/gabapentin

Treat spasticity with Baclofen/Diazepam

Treat Hyperactive bladder with Oxybutinin



What is the diagnosis?

What is the best next step in managing this patient?

Which is single best investigation to diagnose??


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