Paper details
Adele spencer is a 45 y/o F that c/o of worsening vision. The pt noticed difficulty with viewing distance
objects. The pt previously had 20/20 vision. The pt reports blurry vision, and double vision when looking to
the side, but denies having eye pain. The pt was previously seen a few months ago for right arm weakness,
which had improved for a period of time, but began to worsen. She reports weakness in the right arm with
clumsiness, numbness, tingling, but denies pain. FH is notable for a recent stroke in father.
BP 120/60, HR 76, R 18
MSE: as stated age, downward gaze, worried mood, congruent but restricted affect, speech is normal,
thought process linear and logical, thought content worry over sx, no hallucinations or delusions, retained
cognitive functioning.
PE: left pupil is dilated and slow reactive, afferent pupillary defect, left eye 20/200, optic disc paleness, and
edematous. R UL 4/5 strength, impaired light touch, pain, perception, vibration, position sense, 3+ DTR.
1) MS
central and peripheral neuropathy that are disseminated in time and space.
2) conversion disorder 3) peripheral neuropathy 4) cervical radiculopathy
Will want to rule in MS with MRI, if negative will f/u with CSF and oligoclonal bands. Acute management will
be IV prednisone 500mg/day for 3 days then will start chronic management based on patient’s
please inculd plan of care .