Case history
Case history #1
A 28-year-old white woman who was raised in the northern US and has smoked 1 pack per day for the last 10 years presents with subacute onset of cloudy vision in one eye, with pain on movement of that eye. She also notes difficulty with color discrimination, particularly of reds. She was treated for a sinus infection 2 weeks ago and, on further history, recalls that she had a 3-week history of unilateral hemibody paresthesias during finals week in college 6 years ago. She occasionally has some tingling on that side if she is overly tired, stressed, or hot.
Case history #2
A 31-year-old woman with strong family history of autoimmune disease is 6 months postpartum and develops ascending numbness and weakness in both feet, slightly asymmetrically, over a period of 2 weeks. She gradually develops difficulty walking to the point where she presents to an emergency department and is also found to have a urinary tract infection.
Other presentations
MS can present in a myriad of ways in individuals from disparate demographic backgrounds. The most common presentations for MS are optic neuritis and transverse myelitis, but other presentations include brainstem syndromes, cerebellar syndromes (ataxia), and sensory syndromes. Patients may also present with a progressive course, often with foot drop or spastic paraplegias in the later years. Incidental findings of changes on brain magnetic resonance imaging consistent with MS are also reported in asymptomatic patients. MS may present with depression, cognitive decline, or even psychosis, and should be considered in the differential of these disorders, particularly if there are associated physical symptoms or signs.
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