Lynn is a 38 y.o. mother of two, a 10 y.o. girl and a 2 y.o. boy. She is active
ID: 66680 • Letter: L
Question
Lynn is a 38 y.o. mother of two, a 10 y.o. girl and a 2 y.o. boy. She is active and has always enjoyed good health. For the past two weeks, Lynn has been having problems with her right lower extremity during her daily walks. She has noticed that she is tending to catch her toe more, especially toward the end of the walk. It is also harder for her to go upstairs. A physical therapist friend does a manual muscle test on her lower extremities and finds that the left lower extremity tests normal at 5/5, but that the hip and knee muscles of Lynn’s right lower extremity only test at 3/5. The physical therapist recommends Lynn see a neurologist, which she does.
The neurologist performs several diagnostic tests and does two MRIs over the next few weeks. The findings of the tests include the following.
MRI: Evidence of 4-5 plaques in the spinal cord.
Visual Evoked Potential (VEP): Slowed response time.
Blood Tests: Normal.
Cerebral Fluid Analysis: Oligoclonal bands present.
Elevated IgG antibodies.
After approximately 1 month and several other tests, Lynn is given a diagnosis. She is told to expect exacerbations and remissions. Lynn is given glucocorticoids to take during exacerbations.
What is Lynn’s likely diagnosis? Which of the findings of the medical tests support this diagnosis? Which of the findings is the most conclusive for this disease?
What causes this disease? What happens to the nerves in this disease? Are there cognitive deficits?
Does it affect men or women more often? Is it common?
Why is Lynn given glucocorticoids to take during exacerbations, what will they do for her?
How will this disease progress over the next few years? What is the prognosis?
Explanation / Answer
Lynn's likely diagnosis is Multiple Sclerosis. The slow time response along with the elevated levels of IgG antibodies support the diagnosis. The finding of presence of plaques on spinal cord is the most conclusive for this disease because during multiple sclerosis the immune system attacks myelin and replaces it with scar tissue better known as plaque or sclerosis.
The exact cause of disease is still unknown. However, scientists have speculated that it may be caused due to immunologic or genetic reasons. It is an autoimmune, degenerative disease where the body's own immune system attacks the central nervous system. The nerve's myelin is attacked by the immune system and replaced by scar tissue (plaque). Yes, these are cognitive deficits because they cause the impairment of cognition process.
It affects women 2-3 times more often than men. In terms of neurological disease it is the most common disease.
She is given glucocorticoids during exacerbations because these hormones reduce inflammation and thus slow down the progress of the condition.
The condition differs for everyone who has it. The likely prognosis is that though treatment can slow down the progress but the remissions and progress of the disease are inevitable. With time and age the condition gets worse only. There is no permanent cure for this disease.
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