You have been asked to see D.V. in the neurologic clinic. D.V.

has been referred by his

internist, who thinks his patient is having symptoms of multiple sclerosis (MS). D.V. is a 25
YO man who has experienced increasing urinary frequency and urgency over the past 2
months. Because his female partner was treated for an STD (sexually transmitted disease),
D.V. also underwent TX, but the symptoms did not resolve. D.V. has also recently had two
brief episodes of eye fuzziness associated with diplopia and brightness. He has noticed
ascending numbness and weakness of the R arm with inability to hold objects over the past
few days. Now he reports rapid progression of weakness in his legs.

1. MS in an inflammatory disorder of the nervous system causing scattered, patchy

demyelination of the CNS. What does myelin do? What is demyelination?
a. Myelin is a layer of protein and fat that is found around nerves. This fatty
sheath allows for electrical impulses to move quickly between different
nerves.
b. Demyelination is caused by certain diseases in which the bodys immune
system destroys and damages the myelin sheath that covers the nerves.
When this is damaged it could cause the impulses to move very slowly or stop
completely.

2. MS is characterized by remissions and exacerbations. What happens to the myelin

during each of these phases?
a. During remissions, the symptoms of MS are not present and some of the
myelin that was damaged during exacerbation redevelops. During
exacerbations the symptoms of MS are present and the myelin sheath is being
damaged. This causes the impulses to move slowly and interferes with nerve
communication between the brain, spinal cord, and other areas of the body.

3. Isnt D.V. too young to get MS? What is the etiology?

a. According to medicinenet.com MS occurs predominately in younger persons,
b.

with those aged 15 to 45The average age of diagnosis is about 30 years.

However, it can be diagnosed in all ages. So D.V. is not too young to get MS.
MS is an autoimmune disease in which the bodys immune system starts
destroying its own myelin.

4. What assessment data from the case study caused the physician to suspect a
possible diagnosis of MS?
a. Symptoms of MS D.V. is experiencing include:
i. Vision changes. D.V complains of eye fuzziness with diplopia and
brightness.
ii. Numbness and weakness. D.V. has notices numbness and weakness of
the right arm and weakness in his legs.
iii. Inability to empty the bladder. D.V. has experienced increased
frequency and urgency.

5. Diagnostic tests are often done to R/O other disorders with similar symptoms. A
diagnosis will be made when other disorders have been R/O, when the patient has
two or more exacerbations, when there is slow, steady progression, and when the
patient has two or more areas of demyelination or plaque formation. What are four
common diagnostic tests you can begin to teach D.V. about?
a. MRI or Magnetic resonance imaging: which is used to diagnose MS.
b. CT Scans: Can be used, however arent as detailed as MRI.

c. Spinal Tap: Used to confirm the presence of protein in the CSF.

d. Evoked Potential Testing: Measures the nerve response time.
6. D.V. asks you, If this turns out to be MS, what is the treatment?
a. There isnt currently a cure of MS. However there are treatment options that
help recover from attacks or exacerbations more quickly. (The following
information was found on the Mayo Clinic website)
i. Treatment for exacerbations: Corticosteroids and plasma exchange.
ii. Certain medications can be given to lower the amount of
exacerbations.
iii. Treatment for symptoms: Physical therapy, muscle relaxants, etc.

7. As part of your teaching plan, you want D.V. to be aware of situations or factors that
are known to cause an exacerbation of symptoms, list four.
a. Infection: most common are upper respiratory and urinary tract.
b. Stress
c. Fatigue
d. Smoking
e. Seasonal Changes
f. Vitamin D Deficiency
g. Emotional distress

8. Describe several great resources for Multiple Sclerosis Society.

a. The National Multiple Sclerosis Society has several resources, resources for
specific populations, support networks, financial resources and many more.

9. D.V. confides in you that he has been very depressed since his parents divorce and
the onset of these symptoms. He tells you that he knows his girlfriend hasnt been
faithful, but hes afraid of living alone. Hes afraid if he tells her about his M.S.
diagnosis, shell leave him. What are you going to do with this information?
a. Since emotional distress or trauma is a can cause exacerbation of the
symptoms I would refer D.V. to a psychologist to talk about his home situation
with and work through them with the guidance of a psychologist. To hopefully
overcome them to live a happier life with minimal exacerbations.

10. In view of his personal history and current diagnosis, what two critical psychosocial
issues are you going to monitor in his follow-up visits?
a. Depression: D.V. current home situation.
b. Fatigue: Unable to sleep due to newly diagnosis and thinking about parents
recent divorce and his girlfriend.

SOURCES:
"Multiple Sclerosis (MS): Facts on Symptoms and Treatment." MedicineNet. N.p., n.d.
Web. 11 Mar. 2015.
"Multiple Sclerosis." Treatments and Drugs. N.p., n.d. Web. 09 Mar. 2015.

"Multiple Sclerosis: What Triggers Exacerbations?" Multiple Sclerosis: What Triggers

Exacerbations? N.p., n.d. Web. 13 Mar. 2015.