Friday, December 5, 2008

White Spots

A 30 year old woman from Denmark presents with a several year history of intermittent sensory changes in her arms, legs, and face. From time to time, she will get in numbness or tingling but they usually self-resolve in time. She's also had episodes of double vision, vision loss, and problems with walking. On exam, when you flex her neck, she gets electric shock-like sensations that run down her back. T1-weighted MRI monthly scans are shown above.

Challenge: What's the diagnosis?

Related Question:
1. What's the sign elicited on exam?

Image is in the public domain.


Alex said...

MS L'hermitte?

Paul said...

Paul and I say: MS and L'hermitte's sign. :)

P.S. paul got the TB part in the prison case

Craig Chen said...

nice! i can't believe Paul is going into research :P
White Spots

Multiple sclerosis is most common in women of childbearing age from Northern European descent. It is diagnosed by multiple attacks in time or multiple white matter lesions at one time. The symptoms are those described; the sign is Lhermitte's sign. The disease is characterized by relapses and remissions, periventricular plaques on MRI, and IgG oligoclonal bands in the CSF. The pathology shows multifocal areas of demyelination with loss of oligodendrocytes and astroglial scarring; axonal injury is likely the prominent feature.

Sources: UpToDate; Wikipedia.