Case 2




A 25-year old woman complaining about difficulty walking, stumbling, and a tendency to fall. On questioning, the patient indicates that this has been going on for about 5 months, and she also experiences pain and prickly sensations, as well as occasional muscles weakness. These neurological symptoms seem to get worse with stress, and when she has a cold. The patient further relayed that she was experiencing heart palpitations and experiencing heart burn. She also reported blurred vision and occasional blindness in one eye.


Family history:


Is significant for high blood pressure, cancer and heart disease in the immediate family.


Personal History:


Is significant for mumps and chicken pox as a child, and anemia and allergies with hives later in life. She also had a tubal ligation.


Laboratory studies:


The MRI scan revealed the presence of multifocal white matter lesions.


Spinal tap revealed the presence of oligoclonal (immunoglobulins) bands in cerebral spinal fluid (CSF).


Visual evoked response testing was abnormal with slowed conduction in optic nerves.




  1. List all the symptoms in this patient’s history that may lead you to the suspected diagnosis. Discuss your differential strategy for eliminating other disorders as a diagnosis.


  1. What does the presence of oligoclonal (immunoglobulins) bands in the CSF indicate? Does this test help you with diagnosing the patient’s condition? Also, which type(s) of glia may be active?


  1. What is the most likely cause of the vision symptoms? Please provide an explanation that is consistent with the patient’s condition. In addition, where along the visual pathway do you expect a defect? Optic nerve, optic tract, and /or visual cortex?


  1. What other neurological conditions can result in generalized white matter lesions evident on the MRI? Give 3 specific examples and describe their pathological symptoms.


  1. Explain the mechanisms that affect the conduction velocity of an electrical signal within an axon.


  1. Explain whether the neuron’s ability to generate an action potential is compromised in this disease?


  1. Given the above-mentioned symptoms can you hypothesize how the length constant (lamba) would change or not change in the motoneuron: axon hillock, healthy axon segment, demyelinated axon segment compared to the cell soma.


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