Theme 9: Multiple Sclerosis.

Task 1.
A woman 25 years appeared moderate pain behind his right eyeball. The next day she
noticed blurred vision in that eye. When the fundus ophthalmoscopy revealed discoloration of
the temporal half of the optic nerve.Neurological examination: a revival of tendon reflexes in
the hands and feet, the absence of abdominal reflexes, Babinski sign on the right.
1. Neurological syndromes?
2. Location of the lesion?
3. Preliminary clinical diagnosis?
4. Additional studies?
5. Treatment?
Task 2.
A man 25 years old during the week growing weakness in his right leg and instability
when walking. In a survey said that at age 18 he had during the week was decreased vision
left eye. Go to the doctor about it did not apply, since the vision itself was restored. Two years
ago he began to notice compelling urge to urinate and reduced potency.

In the neurological status: horizontal nystagmus, loss of strength in his right

leg up to 4 points, the recovery of knee and Achilles reflexes right Babinski sign on
the right, staggering in the sample Romberg and walking with my eyes closed,
reduced vibration sensation on my feet.
1. Neurological syndromes?
2. Location of the lesion?
3. Preliminary clinical diagnosis?
4. Additional studies?

5. Treatment?

Problem 3.

Male 40 years old complained of leg weakness, gait disturbance, double vision
when looking to the right. He considers himself a patient for 15 years, when first
noted transient weakness in the legs. During several exacerbations of the disease
was noted with weakness in the legs and partial recovery. In the last year there was
a gradual increase in weakness in the legs, gait disturbance, double vision and
urgency to urinate.
In the neurological status: monocular nystagmus of the left eyeball when you
look to the left, we were chanting, intention tremor when the paltsenosovoy
samples from both sides, weakness in the legs up to 3 points, the recovery of
tendon reflexes, and Babinski signs Tremnera on both sides, while walking
neystoychivost and in a sample of Romberg.
1. Neurological syndromes?
2. Location of the lesion?
3. Preliminary clinical diagnosis?
4. Additional studies?

5. Treatment?
Task 4.

In men, 50 years for five years, gradually developing weakness in the legs,
fatigue when walking and voiding the type urgency.
In the neurological status: loss of strength in his legs to 3 points with increased
muscle tone by spastic type, high-tendon reflexes, pathological symptoms Babinski
and Oppenheim both sides. In the study of the fundus revealed discoloration of the
temporal half of the optic nerve. By magnetic resonance tomography of the head
revealed foci of increased signal intensity in T2 mode, located in the corpus
callosum and spinal cord. In the study of visual and somatosensory evoked
potentials showed slowing of conduction in the level of the spinal cord and brain
stem.
1. Neurological syndromes?

2. Location of the lesion?

3. Clinical diagnosis?

4. Treatment?
Task 5.

A woman 40 years from the age of 20 a recurring reduction of the right eye. In
25 years there has been an episode of instability when walking, which is then
completely regressed. At the age of 30 years - numbness and weakness in the legs,
also completely disappeared. Since 35 years the patient had been a continuous
increase in weakness in the legs, as well as voiding as inability to hold urine long.
Neurological status: loss of strength in the lower limbs up to 3 points,
increased muscle tone in them spastic type, the recovery of tendon reflexes,
absence of abdominal reflexes, positive symptoms Tremnera, Babinski and
Oppenheim both sides.
1. Neurological syndromes?
2. Location of the lesion?
3. Preliminary clinical diagnosis?
4. Additional studies?

5. Treatment?
Task 6.

A young man of 18 complained of decreased vision left eye. Five days ago,
there was pain over the left eye, the eye movements were apple painful. Two days
ago, said reduction of the left eye. On examination, an ophthalmologist revealed a
central scotoma in the left eye. In the neurological status: no abdominal reflexes,
the recovery of tendon reflexes and Babinski sign on both sides.
1. Neurological syndromes?
2. Location of the lesion?
3. Preliminary clinical diagnosis?

4. Additional studies?

5. Treatment?
Task 7.

Female 24 years old worries awkwardness in their hands, as well as

uncertainty in walking, especially in the dark. These violations have been reported
for two weeks and gradually increase. Two years ago, during the month
experienced as voiding difficulty in holding urine.
In the neurological status: reducing joint and muscle sense and vibration
sensation in the hands and feet, when the promahivanie paltsenosovoy
pyatochnokolennoy samples and with eyes closed, instability in the sample
Romberg and walking with your eyes closed. When tilting the head forward patient
feels the passage of electric current through the spine. By magnetic resonance
tomography of the head in the T2-detected lesions increased signal intensity,
located in the spinal cord and around the brain ventricles. In the study of
somatosensory evoked potentials found slowing of conduction in the spinal cord
level.
1. Neurological syndromes?
2. Location of the lesion?
3. Clinical diagnosis?

4. Treatment?
Task 8.

Male 30 years old, for the past five years there has been intermittent and shortterm (within a few days or weeks), reduced vision in the left eye, staggering when
walking, compelling urge to urinate. Only mentioned five deterioration and they
completely regressed. Ophthalmologic examination revealed a discoloration of the
temporal half of the optic nerve. In the neurological changes were found in the
period, when a man does not note any complaints. In the study of visual evoked
potentials found slowing of visual impulses in the brain.
1. Preliminary clinical diagnosis?

2. Additional studies?

3. Treatment and prognosis of the disease?

Target 9.

Woman 55 years of patients with 18 years of age when he first noted

numbness in the legs. In 35 years there is a weakness leg muscle. For 20 years,
periodic degradation in the form of growth of weakness in the legs, discomfort in
your hands. In the last three years there has been a gradual deterioration, the patient
can move only within the apartment with assistance.
In the neurological status: horizontal and vertical nystagmus, we chanted,
coarse intention tremor when the paltsenosovoy sample, a decrease in muscle
strength in the legs up to 2 points with increased muscle tone by spastic type, the
recovery of tendon reflexes, clonus of both feet, the symptoms Tremnera, Babinski
and Rossolimo on both sides, the instability in the sample Romberg, dysfunction of
the pelvic organs in the form of urgency to urinate.
1. Neurological syndromes?
2. Location of the lesion?
3. Preliminary clinical diagnosis?
4. Additional studies?

5. Treatment?
Task 10.

A girl of 18 years complains of decreased vision right eye. A week ago, there
was a pain behind his right eyeball, and then for a few days in that eye visual acuity
decreased to two decimal places, the movements of the eyeball were
painful. Ophthalmologic examination revealed a central scotoma in the right eye. In
the neurological status of paresis and other neurological disorders have been
identified. By magnetic resonance tomography of the head in the T2-, revealed
multiple foci of high signal intensity, located in the corpus callosum and around the
ventricles of the brain.
1. Clinical diagnosis?

2. Additional studies?

3. Treatment and prognosis of the disease?

Target 11.

Male 25 years in the past six months have seen on physical fatigue, the
appearance of the instability and weakness in his right leg during prolonged
walking.
In the neurological status: horizontal nystagmus, the recovery of tendon
reflexes in all extremities, absence of abdominal reflexes, Babinski sign on the
right, a slight lurch in the sample Romberg. In the study of visual and
somatosensory evoked potentials showed slowing of conduction in the level of the
spinal cord and brain stem.
1. Neurological syndromes?
2. Location of the lesion?
3. Preliminary clinical diagnosis?
4. Additional studies?

5. Treatment?
Task 12.

Male 38 years old ill for the past 15 years. During this time, periodically
observed the following violations: reduction of the left eye, followed by reduction,
temporary weakness in the legs, compelling urge to urinate. In the last year there,
and gradually increasing weakness in the legs.
In a study of: a decrease in muscle strength in the legs up to 3 points higher
tendon reflexes, ankle clonus, pathological stopnye reflexes, increased muscle tone
in the legs by spastic type, reducing joint and muscle sense and vibration sense in
the legs, unsteadiness in the Romberg and walking on closing the eyes.
1. Neurological syndromes?
2. Location of the lesion?

3. Preliminary clinical diagnosis?

4. Additional studies?

5. Treatment?
Task 13.

Female 25 years old complained of unsteadiness of gait. Sick since age 18,
when he noted that the urge to urinate can not long retain urine. Then these things
have passed, but a year later there was uneasiness in his right hand, which also
regressed. In the last three months was the mark that gait became shaky - "take a
drunk."
In the neurological status: horizontal and vertical nystagmus, intention tremor
in light paltsenosovoy right sample, expressed intention tremor at
pyatochnokolennoy sample from both sides, staggering in the Romberg and
walking, paresis and no sensitivity disorders, lack of abdominal reflexes, the
recovery of tendon reflexes in all limbs, abnormal jog no symptoms.
1. Neurological syndromes?
2. Location of the lesion?
3. Preliminary clinical diagnosis?
4. Additional studies?

5. Treatment?
Target 14.

Male 26 years old complained of weakness in his legs and clumsiness in the
hands, which appeared last week and gradually increase. Five years ago, suffered a
right-sided optic neuritis with good recovery of vision. At the time of magnetic
resonance imaging of the brain in T2-defined multiple foci of high signal intensity,
mainly around the ventricles.
In the neurological status: loss of strength in his legs to 3 points, the recovery
of tendon reflexes, ankle clonus, Babinski sign on both sides, intetsionny tremor in
finger-nose test and disdiadohokinez both sides.

1. Neurological syndromes?
2. Location of the lesion?
3. Preliminary clinical diagnosis?
4. Additional studies?

5. Treatment?
Target 15.

The boy's 10 years on the fifth day of measles appeared uncomfortable in the
hands and feet, unsteadiness when walking. On examination, consciousness
meningeal symptoms are not clear, the horizontal and vertical nystagmus, the
strength in the limbs enough, muscle tone and deep tendon reflexes are low,
intention tremor when the finger-nose and heel-knee tests, disdiadohokinez in both
hands, unsteadiness in walking and in a sample Romberg, no other neurological
disorders.
1. Neurological syndromes?
2. Location of the lesion?
3. Preliminary clinical diagnosis?
4. Additional studies?

5. Treatment?
6. Prognosis?