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A 38-year-old woman is referred to a neurologist because she complained of visual loss and muscle weakness. Subsequent examination revealed additional signs: impairment of other sensations, which included tingling and burning sensations; weakness of the lower limbs; paralysis of the upper limbs; progressive impairment of gait; signs of UMN involvement (i.e., spasticity and increased tendon reflexes); and bladder disturbances. No signs of infection were detected as measured by blood analysis, cultures, and chest x-ray. However, elevations in CSF protein were noted as well an abnormal IgG synthesis. Which of the following is the most likely diagnosis?
A. Diffuse cerebellar degeneration
B. ALS
C. Multiple sclerosis MS
D. A peripheral neuropathy
E. A prefrontal cortical brain tumor
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Yeah agree multiple sclerosis
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Correct.
Multiple sclerosis is a demyelinating autoimmune disease that affects CNS function. This disorder produces a wide variety of symptoms, including sudden sensory dysfunction and loss, which affect vision and the somatosensory system, causing tingling, pain, and hypesthesia. Broad functional motor disturbances also occur, including weakness of the upper or lower limbs, UMN signs, and gait impairment. There is also bladder dysfunction as well as an increase in CSF protein and IgG synthesis. Diffuse cerebellar degeneration would produce gait ataxia and deficits in the accuracy of intentional movements. As noted earlier, ALS would produce both a UMN and an LMN paralysis, which typically does not extend to sensory functions. Likewise, a peripheral neuropathy would not produce UMN signs, visual deficits, and extensive motor disturbances as described in this case. A tumor of the prefrontal cortex would affect some cognitive and emotional functions, but it would not affect sensory processes such as vision and somatosensation, nor would it produce signs of a UMN disorder or muscle weakness.
