Vertical nystagmus as isolated presentation in a patient with new diagnosis of multiple sclerosis

Background: Since 1959, multiple sclerosis (MS) prevalence has been estimated for the east coast Australian city of Newcastle. Previous surveys, conducted in 1988 and 2003, have described an increase in the prevalence and incidence of MS. Objectives: In this study, we evaluated whether these trends continue and provide 50 years of MS epidemiological follow-up for this southern hemisphere city. Methods: Expressed per 100,000 people, prevalence of MS in Newcastle was calculated for those with a confirmed diagnosis of MS on 9 August 2011 and incidence based on the number of cases with MS diagnosis made during the preceding decade. Data were age-standardised to the total Australian population. Statistical comparisons were undertaken using Poisson regression analysis. Results: In 2011, the estimate of MS prevalence was 124.2, with female-to-male ratio reaching 3.1, a 53% increase in female predominance since 1996. MS incidence increased to 6.7, with a significantly higher proportion of new female cases since the previous survey. Conclusion: Prevalence of MS in Newcastle has risen linearly and is contributed to by a substantial increase in new cases over the preceding decade. Female predominance of MS cases continues to increase with a new diagnosis three times more likely in women.

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Isolated Abducens Palsy as the First Presenting Sign of Multiple Sclerosis

Case Reports in Neurology ◽

10.1159/000455023 ◽

2017 ◽

Vol 8 (3) ◽

pp. 272-275 ◽

Cited By ~ 4

Author(s):

Sargon Bet-Shlimon ◽

Mill Etienne

Keyword(s):

Multiple Sclerosis ◽

Differential Diagnosis ◽

Brain Stem ◽

Cranial Nerve ◽

Prior History ◽

Abducens Palsy ◽

Cranial Nerve Palsies ◽

Pontine Lesion ◽

History Of ◽

New Diagnosis

While brain stem involvement in multiple sclerosis (MS) is relatively common, isolated cranial nerve palsies are rare, especially when they represent the initial presenting sign of a new diagnosis of MS. This report describes a patient with no prior history of MS whose sole presenting sign was an isolated abducens palsy. An enhancing pontine lesion was found on MRI which correlated with his abducens palsy, and additional nonactive lesions on MRI led to a diagnosis of MS. This case demonstrates the importance of considering MS as part of the differential diagnosis of patients with isolated cranial nerve palsies.

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Methylprednisolone-induced hepatotoxicity in a 16-year-old girl with multiple sclerosis

BMJ Case Reports ◽

10.1136/bcr-2018-226687 ◽

2018 ◽

Vol 11 (1) ◽

pp. e226687 ◽

Cited By ~ 3

Author(s):

Eleonora Rotondo ◽

Alessandro Graziosi ◽

Vincenzo Di Stefano ◽

Angelika Anna Mohn

Keyword(s):

Multiple Sclerosis ◽

Chronic Inflammatory Disease ◽

High Dose ◽

First Line Therapy ◽

Elevated Liver Enzymes ◽

High Dose Methylprednisolone ◽

The Central Nervous System ◽

High Doses ◽

Hepatocyte Necrosis ◽

New Diagnosis

Multiple sclerosis (MS) is a chronic inflammatory disease with demyelination of the central nervous system. High-dosage corticosteroids are the first-line therapy in the acute relapsing of MS. We report a case of severe high-dose methylprednisolone-induced acute hepatitis in a patient with a new diagnosis of MS. A 16-year-old girl was admitted for urticaria, angioedema, nausea and vomiting a month later she had been diagnosed with MS and treated with high-dosage methylprednisolone. Laboratory investigations showed hepatic insufficiency with grossly elevated liver enzymes. A liver biopsy showed focal centrilobular hepatocyte necrosis with interface hepatitis. Methylprednisolone-induced hepatotoxicity can confuse the clinical picture of patients with MS and complicate the differential diagnosis. We believe that each specialist should know it and monitor patients with MS taking high doses of methylprednisolone. As there is no screening model that predicts idiosyncratic hepatotoxicity, we promote screening for potential liver injury following pulse steroid therapy.

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“Her Illness Is a Project We Can Work on Together”

International Journal of MS Care ◽

10.7224/1537-2073.2012-022 ◽

2013 ◽

Vol 15 (3) ◽

pp. 130-136 ◽

Cited By ~ 2

Author(s):

David Rintell ◽

Richard Melito

Keyword(s):

Quality Of Life ◽

Multiple Sclerosis ◽

Crisis Intervention ◽

Family Members ◽

The Family ◽

New Diagnosis ◽

The Impact ◽

Family Centered

This article presents a model for intervening with families that are addressing a new diagnosis of multiple sclerosis (MS) in one member. The model is collaborative, integrative, and family-centered. It involves both working with the family collaboratively and providing strategies to promote greater collaboration within the family. The model integrates elements of crisis intervention theory, psycho-education, and family-centered approaches. The model was developed with families addressing MS, and was piloted with three families. The intervention was found to improve family members' ability to collaborate with each other. Such increased collaboration may enhance the family's ability to manage long-term illness more effectively, help the family address the impact of the illness on all family members, and generally improve the family's quality of life.

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