Superficial sensation in lower extremities some

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superficial sensation in lower extremities, some swaying in Romberg’s test, mild intention tremor during finger-to-nose test, scarce non-symmetry of mimic muscles. Blood assay – normal. CSF assay – normal. Fundoscopy – doubtful discoloration of the optical discs. What is your diagnosis? Describe algorithm of treatment. Diagnosis – MS, primary progressive form Affection of cerebellum, spinal cord lateral and posterior white columns at lumbar level of SC Treatment : Cytostatic to decrease progression- azathioprine Symptomatic treatment: carbamazepine for tremor Preventive treatment of exacerbations: Beta-interferons (bethaferon) Selective immunomodulators (copaxone) Monoclonal antibodies (daclizumab) 2 Patient, female, in age of 26 years, was admitted to the hospital with complaints of difficulty during walking because of disbalance and urinary retention. This condition developed during recent 2 days and was preceded by intensive insolation. 10 months ago she had short-lasting (2 days) episode of unilateral blindness that resolved without treatment. Her vital parameters: BP – 120/75 mm Hg, pulse – 68 beats/sec., breath rate – 14/sec. During neurological examination next signs were revealed – deep sensation hypesthesia and moderately increased tendon reflexes on legs, positive bilateral Babinski’s and Gordon’s signs, unilateral mild external ophtalmoplegia, moderate intention tremor and swaying in Romberg’s test. Blood assay – normal. CSF assay – cell count 5/mm 3 , lymphocytes, slightly elevated level of protein which contains IgG. Fundoscopy – discoloration of the temporal halves of the optical discs. What is your probable diagnosis? How to confirm it? Describe algorithm of treatment. Diagnosis – MS, relapsing-remitting form Confirmation – MRI, evoked potentials, immunological tests Treatment: corticosteroids (methylprednisolone), IV infusion of human IGs, plasmapheresis, Preventive treatment of exacerbations: Beta-interferons (bethaferon) Selective immunomodulators (copaxone) Monoclonal antibodies (daclizumab) Symptomatic treatment: oxybutinin (urinary retention) carbamazepine (for tremor) 3 Patient, female, in age of 38 years, is admitted to the hospital with complaints of arms’ muscular wasting, loss of temperature sensation and ulcers on upper extremities. This condition has been existing and slowly-progressing for almost 10 years. Her vital parameters: BP – 120/75 mm Hg, pulse – 77 beats/sec., breath rate – 15/sec. Visual examination – scapular winding. During neurological examination next signs were revealed – torpid tendon and periosteal reflexes from the upper extremities, wasting and ulceration of hands’ muscles, fresh and old burns of palms, superficial sensation loss on trunk and arms. Blood assay – normal. CSF assay – non-specific. Fundoscopy – non- specific. What is your diagnosis? What neural structures are affected in this disease?
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  • Winter '18
  • Jane doe
  • Neurology, Seizure, Seizure types

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