Jane,33, awakens on morning with blurred vision and pain in her right eye. She s
ID: 3516294 • Letter: J
Question
Jane,33, awakens on morning with blurred vision and pain in her right eye. She sees her family physician, who determines that her sclera, conjunctiva, cornea and ocular tension are normal, but that her visual acuity is markedly reduced in that eye. An ophthalmologist is consulted and, after an exam, diagnoses optic neuritis. Jane is then referred to a neurologist, who learns that she had an earlier, previously forgotten episode of weakness and clumsiness of her left arm. That problem persisted for only two days and Jane attributes it to lifting heavy suitcases on a trip. An MRI of her brain reveals several plaque- type lesions in the white matter of the brain but no other abnormalities. A lumbar puncture is performed, and the results are as follows: pressure: 150mm/H2o, color: clear, colorless, Glucose:50mg/dL, protein: 50mg/dL, cells: no RBCs; WBC count of 6/mm3. IgG: high ration of IgG to other proteins, culture: no bacteria. What is Jane preliminary diagnosis? Explain in detail WHY? Mentioning absolutely all the lumbar puncture lab results in your answer/ diagnosis. Jane,33, awakens on morning with blurred vision and pain in her right eye. She sees her family physician, who determines that her sclera, conjunctiva, cornea and ocular tension are normal, but that her visual acuity is markedly reduced in that eye. An ophthalmologist is consulted and, after an exam, diagnoses optic neuritis. Jane is then referred to a neurologist, who learns that she had an earlier, previously forgotten episode of weakness and clumsiness of her left arm. That problem persisted for only two days and Jane attributes it to lifting heavy suitcases on a trip. An MRI of her brain reveals several plaque- type lesions in the white matter of the brain but no other abnormalities. A lumbar puncture is performed, and the results are as follows: pressure: 150mm/H2o, color: clear, colorless, Glucose:50mg/dL, protein: 50mg/dL, cells: no RBCs; WBC count of 6/mm3. IgG: high ration of IgG to other proteins, culture: no bacteria. What is Jane preliminary diagnosis? Explain in detail WHY? Mentioning absolutely all the lumbar puncture lab results in your answer/ diagnosis.Explanation / Answer
A lumbar puncture or spinal tap is to collect the cerebrospinal fluid and test for any abnormalities which give an indication of problems in the brain and spinal cord. It is very effective in diagnosing diseases such as meningitis, neurologic diseases or effect of any systemic disease on the brain and spinal fluid.
The normal values for spinal fluid examination are as follows --
* Protein [ 15 to 45 mg/dl]
* Glucose [ 50 to 75 mg/dl]
* Cell count [ 0 to 5 mononuclear cells]
* Initial pressure [ 70 to 180 mm ]
These normal values can be altered by injury or disease of the brain, spinal cord or adjacent tissues.
The readings of Jane's cerebrospinal fluid are all within range except for the slightly higher value of the protein content and the WBC count. The glucose level is just within the range, being towards the lower limit.
Optic neuritis can be caused by certain bacterial infections or viral infections like measles , mumps, herpes simplex or even by auto immune disorders. Sometimes optic neuritis is also result from multiple sclerosis.
The lesions on the brain point towards some abnormality in the nerves of the brain. In people with multiple sclerosis , the body's own immune system attacks the tissue surrounding the nerve fibers in the brain, spinal cord and the optic nerve. The myeline sheath covering the nerve axons are attacked and damaged and as a result of this the nerves are not able to function properly.
From the MRI results and the lab report of the lumbar puncture, it seems that Jane is suffering from multiple sclerosis which might have been triggered by some pathogenic infection.
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