Managing Multiple Sclerosis at an Early Stage

Patient History and Introduction

While on vacation in Florida, a 27-year-old man presents to an emergency department with a 5-day history of abrupt-onset hazy vision in his right eye. He is also experiencing right facial and leg numbness that began approximately 24 hours after the initial symptom. The patient reports he has never experienced such symptoms or other neurological difficulties in the past but does admit to having recent problems with fatigue and memory. He is not taking any medications and states he is in excellent health. Family history reveals that his mother has relapsing-remitting multiple sclerosis (MS), diagnosed 18 years ago.

A neurologist was brought in for consultation. The neurological examination revealed visual acuity in the right eye of 20/200, a right afferent papillary defect, and decreased sensation to touch and pin in the right face and arm. The remainder of the neurological examination was unremarkable except for unusually brisk, but symmetric lower extremity reflexes. Magnetic resonance imaging (MRI) of the brain was ordered.