■ Limited bulbar and ocular involvement
■ Ventilatory failure is uncommon.
DIAGNOSIS
■ Clinical diagnosis is based on personal and/or family history of similar episodes.
■ ECG may show findings consistent with hyper- or hypokalemia.
■ Serum K+levels
TREATMENT
■ Supportive care
■ Treat underlying electrolyte abnormalities.
■ Treat hyperthyroidism, if present.
A 30-year-old female presents to the ED complaining of pain with eye
movement and visual changes in her right eye. She denies trauma or
other complaints. Upon further history, the patient reports transient
episodes of hand or leg weakness over the past few years. She has never seen a
physician for this. On examination, the pupillary response to light is decreased in
the affected eye and fundoscopic examination shows a blurred optic disc. What
is the treatment for this patient’s presenting illness?
This patient likely has MS and is presenting with optic neuritis. Intravenous
(not oral) steroids is the recommended treatment.MULTIPLE SCLEROSISPATHOPHYSIOLOGY
Genetic and environmental factors →inflammatory reaction →regions of
CNS demyelination with sparing of axons.
SYMPTOMS/EXAM
■ Characterized by episodic neurologic dysfunction that onsets rapidly, then
slowly resolves
■ May involve any aspect of the CNS (cranial nerve findings, motor
weakness, cerebellar dysfunction, cognitive changes, bowel/bladder
dysfunction)
■ Optic neuritisis often the presenting finding and is the most common
cranial nerve finding; it is characterized by eye pain that is worse with eye
movement followed by scotoma of central vision.
■ Internuclear ophthalmoplegia: Abnormal horizontal eye movements due
to lesion of the medial longitudinal fasciculus; may also be seen (less com-
monly) in brainstem vascular lesions, hypertensive crisis, trauma, cocaine
use, and SLE
■ Uhthoff phenomenon: Small increases in body temperature (eg, exercise,
fever)→worsened symptoms.
■ Lhermitte phenomenon: Electric shock sensation down spine with flexion
of neck
NEUROLOGY