Multiple Sclerosis: Practice Cases
Patient 1: Janelle—Feet numbness Tap the arrow to view the case.A 43-year-old architect presents to the ED with 2 days of bilateral ascending numbness that started in her feet. She has also noticed difficulty climbing stairs and dancing last night was “impossible, and I’m usually really coordinated.” Her current medications are vitamin C for colds, […]
MS Case Studies 2–5
Case study 2: Mariah—Where is the lesion? Tap the image to view the case. A 32-year-old woman presents with right-leg weakness and has to use a stick for support. She also has numbness in the left foot and leg. She has been well, but had a measles vaccine 2 weeks ago from her GP. Strength […]
Case Study 1: My Feet Are Numb
Case study 1: Isla—My feet are numb Tap the image to view the case. A 32-year-old tourist from Scotland presents to the ED with 6 days of bilateral ascending numbness that started in her feet. While standing barefoot on a tile floor, she noticed that she could not feel the cold with her right foot. […]
4. Multiple Sclerosis and Mimics
Author Dawn DeWitt, MD In this module Multiple Sclerosis (MS) is a common neurological condition of the central nervous system that you are likely to encounter in your practice, regardless of your specialty. MS is a chronic CNS condition that is commonly remitting/relapsing but can also be progressive. Misdiagnosis is an ongoing issue since a […]
References
Websites Tension Headaches. National Health Service (NHS), United Kingdom. ICHS Classification ICHD-3. International Headache Society. Cluster Headache Treatment Options. American Migraine Foundation. Feb.13, 2020. Books and articles Rizzoli, P. MD, FAHS and Mullally, W. MD, FAHS. Headache. American Journal of Medicine, vol. 131, No. 1, Jan. 2018. Jacobs B, Dussor G. Neurovascular contributions to migraine: […]
Headache: Practice Cases
Patient 1: Steve—Right-sided headache Tap on the image to see the case. A 55-year-old man comes to see you for recent onset of right-sided headaches which he refers to as “migraines.” He has some nausea with his headaches. He has no other symptoms with the headaches. Question Along with a careful neuro exam, the best […]
Case Study 3: Frequent Migraines
Case study 3: Jody—Frequent migraines Tap the arrows to view the case.Today’s patient is a 30-year-old grocery clerk who is visiting the clinic to discuss management of her increasingly frequent migraines. She reports an 18-year history of migraines with interval headaches. Her mother and brother also have migraines. She says she is usually sensitive to […]
Case Study 2: Worst Headache of My Life
Case study 2: Tommy—Worst headache of my life Tap the image to view the case. A 22-year-old drummer is found unconscious by his girlfriend the morning after a performance and party. He tells her he woke up with a mild hangover and suddenly had a “horrible headache, and then I woke up with you here […]
Case Study 1: Worsening Migraines
Case study 1: Amanda—Worsening migraines Tap the image to view the case. Amanda is a 30-year-old female who has had “migraines” since the age of 17 years. She presents for the first time because “I’m having them at least 2 weeks out of every month!” Physical exam findings non-focal. Stop and recall exercises: Free recall […]
3. Headache and Migraine
Author Keely Coxon, MDDawn DeWitt, MD In this module Epidemiology of headaches Very high lifetime prevalence: 96% by some estimates. Migraines: Very common between ages 25–55. Female predominance (headaches overall and migraines); except cluster headaches. Headaches are a significant cause of morbidity and missed work. Approach: First distinguish between . . . Primary headache. Secondary […]