Concluded Case

1St Episode of Multiple Slerosis.

New case 29 yr,F ,No known comorbidities, presented withrtsided unsteadiness 3 days with feeling of things are removing infront of the eyes since 2 days. No head ache/ vertigo .Denied having any symptoms of vasculitis. Not on any hormonal med. On exam ,Np 120/ 80 mmhg .No external stigmata of vasculitis. Optic fundi normal.Rt eye is not adducting full and left eye shows nystagmus on left lateral position. Power gr5/ 5 , rt sided cerebellar signs with difficulty for tandom walking Routein hematology normal. CSF NORMAL STUDY including oligoclonal band.Vascutilis screening normal. VEP ,ABER,SEP normal. What is the diagnosis and what abnormality in the MRI?.

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Thanks Curofy & Others. Discussion: What is the diagnosis? What abnormality in the MRI? 1st episode of demyelinating disese ,MS. MRI brain - T2 / FLAIR hyperintense signals noted in the Rt anterolateral basal pons. No restriction diffusion or enhancement noted. Rest of the brain parenchyma is normal. MRI cervical spine- T2 hyperintense lesion at C6 level in the left lateral aspect of the cord with mild contrast enhancement. Rest of the spine normal.
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Thanks Curofy & Others. Discussion: What is the diagnosis? What abnormality in the MRI? 1st episode of demyelinating disese ,MS. MRI brain - T2 / FLAIR hyperintense signals noted in the Rt anterolateral basal pons. No restriction diffusion or enhancement noted. Rest of the brain parenchyma is normal. MRI cervical spine- T2 hyperintense lesion at C6 level in the left lateral aspect of the cord with mild contrast enhancement. Rest of the spine normal.
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Thanks Curofy
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Ataxia, INO, nystagmus Likely to be demyelinating(? Primary) Anti NMO, and anti-MOG to be ruled out Automiimune cause should come next as the patient is young female
D/d Primary vs 2ndry demyelination Rt pons t2 hyperinternsity with patchy hypertensity at cervical region ?MS
I agree
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Rt pontine infarct involving MCP. INO rt.

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