ZIAUDDIN UNIVERSITY
PBL-8
Module Name: Central Nervous System
Date of PBL:
MBBS 3rd year (Batch-XXIV)
I can’t eat, write and speak properly
A 28-year-old lady came to the family physician with sudden loss of vision in her right eye last nightthat
resolved within a few hours. She also complaint of tremors in her right hand while writing or eating,
weakness in her legs, urinary incontinence, and difficulty in speaking for a month. She stated that 3
years ago she had an episode of “double vision” that lasted few hours and resolved on its own. Family
history revealed her mother had similar symptoms.
General Physical Examination:
An adult female of average height and built, well oriented in time, place and person.
Vitals:
B.P: 110/70 mmHg
Temp: 98oF
Pulse: 80 beats/min
R/R: 18 breaths/min
Pallor: Not present
Jaundice: Not present
Cyanosis: Not present
Dehydration: Not present
Clubbing: Not present
Pedal Edema: Not Present
Lymph nodes: Not palpable
Thyroid: Not enlarged
Systemic examination:
HEENT: Non-significant
Respiratory System: Normal vesicular breathing.
Cardiovascular system: S1, S2 audible with no added sounds.
Abdomen: Abdomen was soft and non-tender with no visceromegaly. No sign of shifting dullness.
Bowel sounds audible.
CNS:
CNS examination revealed:
Right eye:Limited adduction; Indirect light reflex: +ve; Direct light reflex: -ve
Left eye:Abducting nystagmus.
Motor examination of lower extremities showed hyperreflexia in both legs with spastic tone
Laboratory findings:
CBC
Hb: 13.2 mg/dl
RBCs: 4.5 x 1012 / ml
WBCs: 9 x 109 /L
Platelets: 250 x 10 9 /L
Lumbar puncture was performed and CSF was sent for D/R and C/S.
CSF Findings:
CSF revealed; Oligoclonal Immunoglobulin Bands, IgG index: 0.89
Protein: 50 mg/dl, WBC count: 5 cells / mm3
MRI:
MRI brain (without contrast) showing classic demyelination (asymmetric hyperintense lesions)
Management:
Inj. Interferon beta-1b 30 mcg IM qwk
Inj.Natalizumab 300mg infusion q×4wk
Inj. Methylprednisone 500mg IV for 5 days
Symptomatic treatment was given for neurogenic bladder, spasticity, and pain.
TASK: Discuss the concepts of basic sciences related to the case (Anatomy, physiology, biochemistry,
pathology, pharmacology and CHS).