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Practical Management of MS in the Primary Care Office Setting

Practical Management of MS in the Primary Care Office Setting. Case Study 2. Case 2: Diagnosis Presentation. Ms. K, a 35-year-old woman, awakened with numbness in her right leg and thorax to level of sternum About 1 week later she developed numbness and tingling in her left hand

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Practical Management of MS in the Primary Care Office Setting

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  1. Practical Management of MS in the Primary Care Office Setting Case Study 2

  2. Case 2: DiagnosisPresentation Ms. K, a 35-year-old woman, awakened with numbness in her right leg and thorax to level of sternum About 1 week later she developed numbness and tingling in her left hand After about 2 weeks the symptoms began to decrease in intensity She presented for neurologic evaluation about 6 weeks after onset; symptoms had almost entirely resolved

  3. Case 2History Ms. K reports that about 15 months prior to current symptoms she had developed a headache, poor depth perception, and balance difficulties A few days later she developed hearing loss in her right ear and right facial numbness She was evaluated by ENT who ordered brain MRI Neurologic symptoms resolved about 3 weeks after onset She was never told the MRI results

  4. Case 2Physical Examination • General examination and mental status are normal • Visual acuity: 20/20 both eyes • Cranial nerves: subtle flattening of right nasolabial fold, otherwise normal • Motor: 4/5 left hand intrinsics, otherwise 5/5 • Sensory: decreased pain/temperature on left vs right • Vibration decreased bilateral great toe • Coordination and gait: normal • Reflexes: 1+ right upper extremity, 2+ left upper extremity, 4+ bilateral patellar, 3+ ankles, toes downgoing bilaterally

  5. Case 2MRI at Time of Second Event

  6. Case 2Discussion Questions • Does this patient meet McDonald criteria for MS? If not, what else is required? • What, if any, additional workup would you perform? • How would you counsel this patient? • Would you start treatment now?

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