You are here
An increasingly common presentation of early MS
Introduction and objectives
•A 25 year old woman with no significant PMHx presented to her PCP with intermittent right-sided pulsatile headaches X6 months associated with phonophobia, photophobia, and nausea.
•Based on these complaints, the patient underwent brain MRI, followed by cervical spine MRI.
•Her headaches spontaneously resolved shortly after MRIs were done.
•Based on MRIs, the patient was referred to our center
•Neurological exam was normal, and the patient denied any neurological symptoms.
•Imaging showed several juxtacortical and periventricular lesions, a posterior fossa lesion, and a C6 right dorsolateral lesion. No abnormal enhancement was seen.
Based on this data,
•what is the diagnosis?
•what is the optimal management?
The patient underwent a lumbar puncture which showed 8 WBCs, normal protein, and >5 unique oligoclonal bands. Would this change management?
We recommended close monitoring with serial imaging and neurological exams.
•Repeat MRI 6 months after showed 2 new enhancing lesions. Based on this new data, what is the optimal management of this patient?
•After careful review of pros and cons of treatment, the patient was started on an MS disease modifying agent.